BEUDAMED
    FDA Adverse Event Other Summary report: N

    *

    MDR report key: 766955 · Received October 3, 2006

    Report

    Report Number
    MW1040582
    Event Type
    Other
    Date Received
    October 3, 2006
    Date of Event
    July 25, 2006
    Report Date
    October 2, 2006
    Manufacturer
    DAVOL, INC
    Product Code
    FTL
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PATIENT DEVELOPED INFECTION AFTER THE INSERTION OF THE DAVOL VENTRALEX MESH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * VENTRALAX PATCH FTL DAVOL, INC * 43ECD778

    Patients

    Seq Age Sex Outcome Treatment
    1 42 YR Other