FDA Adverse Event
Injury
Summary report: N
URETEX SUPPORT PP KIT X1
MDR report key: 3252317
·
Received July 23, 2013
Report
- Report Number
- 9615742-2013-00909
- Event Type
- Injury
- Date Received
- July 23, 2013
- Date of Event
- October 20, 2003
- Report Date
- July 2, 2013
- Manufacturer
- SOFRADIM PRODUCTION
- Product Code
- OTN
- PMA / PMN Number
- K012949
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- GA, US
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
(B)(4).
Description of Event or Problem · 1
PROCEDURE TYPE: UROGYNECOLOGICAL. ACCORDING TO THE REPORTER: THE PATIENT'S ATTORNEY ALLEGED A DEFICIENCY AGAINST THE DEVICE. PRODUCT WAS USED FOR THERAPEUTIC TREATMENT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 341963 | URETEX SUPPORT PP KIT X1 | URETEX SUPPORT | OTN | SOFRADIM PRODUCTION | C23155SUP |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 52 YR | Other | PELVICOL ACELLULAR COLLAGAN MATRIX: LOT# B03B10| SERIAL: (B)(6), EXP: 08/28/2005, MFR: 2002| PELVICOL ACELLULAR COLLAGAN MATRIX: LOT# B03B10| SERIAL: (B)(4), EXP: 08/28/2005, MFR: 2002 |