FDA Adverse Event
Injury
Summary report: N
UNK MAMMARY IMPLANT
MDR report key: 9985621
·
Received April 22, 2020
Report
- Report Number
- 9617229-2020-06874
- Event Type
- Injury
- Date Received
- April 22, 2020
- Manufacturer
- ALLERGAN (COSTA RICA)
- Product Code
- FWM
- PMA / PMN Number
- P990074
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
FURTHER INFORMATION FROM THE REPORTER REGARDING EVENT, PRODUCT, OR PATIENT DETAILS HAS BEEN REQUESTED. NO ADDITIONAL INFORMATION IS AVAILABLE AT THIS TIME. REASON FOR REOPERATION: "DISPLACEMENT," "POSSIBLE RUPTURE," AND "ONE AREA APPEARS ODD."
Description of Event or Problem · 1
PATIENT REPORTED RIGHT SIDE "DISPLACEMENT," "POSSIBLE RUPTURE," AND "ONE AREA APPEARS ODD." DEVICE REMAINS IMPLANTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 449831 | UNK MAMMARY IMPLANT | PROSTHESIS, BREAST, INFLATABLE, INTERNAL, SALINE | FWM | ALLERGAN (COSTA RICA) | NI |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Required Intervention |