BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN- UNSPECIFIED BY COMPLAINANT

    MDR report key: 3800336 · Received April 3, 2014

    Report

    Report Number
    1835959-2014-00125
    Event Type
    Injury
    Date Received
    April 3, 2014
    Report Date
    April 3, 2014
    Manufacturer
    COOK BIOTECH, INC.
    Product Code
    PAG
    PMA / PMN Number
    UNK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    CONCLUSIONS CODE: ROOT CAUSE INCONCLUSIVE DUE TO LACK OF DETAILS PROVIDED BY THE COMPLAINANT. INVESTIGATION INTO THIS CLAIM INCLUDED A REVIEW OF THE CLAIM ALLEGATIONS AND ALL OTHER COMMUNICATION AND INVESTIGATION INTO THIS REPORT/CLAIM IS BEING HANDLED BY OUR ATTORNEY. BASED ON THE INFO PROVIDED BY THE COMPLAINANT, DETAILS REGARDING A SPECIFIC CORRELATION BETWEEN THE UNSPECIFIED SURGISIS GRAFT'S PERFORMANCE AND THE ALLEGED INJURY REMAIN UNK. A ROOT CAUSE OF THE CLAIM ALLEGATIONS IS INCONCLUSIVE DUE TO LACK OF DETAILS PROVIDED BY THE COMPLAINANT. ALL OTHER MATTERS RELATING TO THIS LITIGATION ARE BEING HANDLED BY OUR ATTORNEY. IF/WHEN ADD'L INFO IS OBTAINED A FOLLOW-UP MDR WILL BE FILED.

    Description of Event or Problem · 1

    THE PT WAS REPORTEDLY IMPLANTED WITH A PELVISOFT AND AN UNSPECIFIED SURGISIS GRAFT ON 05 (B)(6) 2007, AT (B)(6) BY (B)(6) M. D. TO TREAT HER PELVIC ORGAN PROLAPSE AND/OR STRESS URINARY INCONTINENCE. THE PT AND HER ATTORNEY HAVE ALLEGED THAT AS A RESULT OF THESE PRODUCTS BEING IMPLANTED IN THE PATIENT, THE PT HAS EXPERIENCED PAIN, INJURY AND HAS UNDERGONE MEDICAL TREATMENT. IN ADDITION TO THE PELVILACE AND UNSPECIFIED SURGISIS GRAFT, THE PT ALSO WAS IMPLANTED WITH A COLOPLAST SLING MESH Y-SHAPED ON (B)(6) 2012, AT (B)(6) BY (B)(6), M.D.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    200407 UNKNOWN- UNSPECIFIED BY COMPLAINANT UNKNOWN PRODUCT UNSPECIFIED PAG COOK BIOTECH, INC. NA UNSPECIFIED

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Disability PELVISOFT