BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SALINE TESTICULAR, MEDIUM

    MDR report key: 507629 · Received January 23, 2004

    Report

    Report Number
    2125050-2004-00027
    Event Type
    Injury
    Date Received
    January 23, 2004
    Date of Event
    December 18, 2003
    Report Date
    December 30, 2003
    Manufacturer
    MENTOR CORP. - MINNESOTA DIVISION
    Product Code
    FAF
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ACCORDING TO THE INFORMATION TESTICULAR DEVICE DEFLATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SALINE TESTICULAR, MEDIUM TESTICULAR PRODUCTS FAF MENTOR CORP. - MINNESOTA DIVISION 450-1327 90498

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO Hospitalization| R