BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SALINE TESTICULAR, LARGE

    MDR report key: 480677 · Received August 29, 2003

    Report

    Report Number
    2125050-2003-00361
    Event Type
    Injury
    Date Received
    August 29, 2003
    Date of Event
    July 30, 2003
    Report Date
    August 18, 2003
    Manufacturer
    MENTOR CORP. - MINNESOTA DIVISI
    Product Code
    FAF
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    DESCRIBE EVENT OR PROBLEM: THERE WAS LEAKAGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SALINE TESTICULAR, LARGE TESTICULAR PRODUCT FAF MENTOR CORP. - MINNESOTA DIVISI 450-1329 789535

    Patients

    Seq Age Sex Outcome Treatment
    1 44 YR Hospitalization| R