Brand Name | GYNECARE TVT SECUR SYSTEM |
Type of Device | MESH, SURGICAL, SYNTHETIC, UROGYNECOLOGIC |
Manufacturer (Section D) |
ETHICON SARL |
puits-godet 20 |
neuchatel NJ 2000 |
SZ 2000 |
|
Manufacturer (Section G) |
DEFAULT ORGANIZATION |
4545 creek rd ml # 36 |
|
cincinnati OH 45242 2803 |
|
Manufacturer Contact |
darlene
kyle
|
route 22 west po box 151 |
somerville, NJ 08876
|
9082182792
|
|
MDR Report Key | 4946267 |
MDR Text Key | 6256286 |
Report Number | 2210968-2015-09711 |
Device Sequence Number | 1 |
Product Code |
PAH
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K052401 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Other,other |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
04/18/2017 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 07/28/2015 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 05/31/2009 |
Device Catalogue Number | TVTS4 |
Device Lot Number | 3041482 |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
No
|
Was the Report Sent to FDA? |
No
|
Date Manufacturer Received | 04/18/2017 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 06/14/2007 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 35 YR |
|
|