REALIZE

Report

• Report Number: MW5038108
• Event Type: Injury
• Date Received: September 5, 2014
• Report Date: September 5, 2014
• Product Code: LTI
• Adverse Event: Yes
• Report Source: Voluntary report
• Reporter Location: OH, US
• Reporter Occupation: PATIENT

Narratives

Description of Event or Problem · 1

I HAD THE BAND INSERTED IN (B)(6) 2008. AFTER ONE YEAR, I HAVE CONSTANT VOMITING. ENDED UP NOT BEING ABLE TO SWALLOW WATER AND HAD TO HAVE IT REMOVED.

Devices

Seq	Brand	Generic	Product Code	Manufacturer	Model	Lot	UDI-DI
543262	REALIZE	GASTRIC BAND	LTI		*	*

Patients

Seq	Age	Sex	Outcome	Treatment
1	36 YR		Required Intervention

Terms

Patient problem · 1

• Vomiting

Product problems · 1

• Adverse Event Without Identified Device or Use Problem

Type of report · 1

• Initial submission