BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SILTEX SALINE

    MDR report key: 77511 · Received March 14, 1997

    Report

    Report Number
    1645337-1997-00018
    Event Type
    Injury
    Date Received
    March 14, 1997
    Date of Event
    January 29, 1996
    Report Date
    March 13, 1997
    Manufacturer
    MENTOR H/S
    Product Code
    FWM
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE PT WAS IMPLANTED WITH A SALINE PROSTHESIS ON 1/19/96. SUBSEQUENTLY IT WAS NOTED THAT THE PT'S RIGHT BREAST HAD DEVELOPED A SEROMA AND CAPSULAR CONTRACTURE. THIS REPORT WAS SUBMITTED TO THE FDA PURSUANT TO NEW "MDR REPORTING GUIDANCE FOR BREAST IMPLANTS" (EFFECTIVE DATE, FEBRUARY 10, 1992). ANY PERCEIVED INCREASE IN FREQUENCY OF EVENTS IS RELATED TO THE FILING OF REPORTS FOR EVENTS, WHICH WERE PREVIOUSLY NOT MDR REPORTABLE EVENTS PER 21CFR803.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SILTEX SALINE Implant MAMMARY PROSTHESIS FWM MENTOR H/S NA 129254

    Patients

    Seq Age Sex Outcome Treatment
    1 42 YR Required Intervention