BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DESARA

    MDR report key: 3240531 · Received July 16, 2013

    Report

    Report Number
    3003990090-2013-00178
    Event Type
    Injury
    Date Received
    July 16, 2013
    Date of Event
    September 19, 2012
    Report Date
    July 16, 2013
    Manufacturer
    CALDERA MEDICAL, INC.
    Product Code
    FTL
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    EVENT WAS REPORTED TO CALDERA MEDICAL BY AN ATTORNEY. LEGAL COMPLAINT STATES THAT PATIENT SUFFERED SERIOUS BODILY INJURIES, INCLUDING, BUT NOT LIMITED TO, EXTREME PAIN, EROSION OF HER INTERNAL BODILY TISSUE, DYSPAREUNIA, PAINFUL SCARRING, AND OTHER INJURIES. NO ADDITIONAL INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    330438 DESARA SURGICAL MESH FTL CALDERA MEDICAL, INC. 109027

    Patients

    Seq Age Sex Outcome Treatment
    1 Other