Brand Name | GYNECARE TVT-ABBREVO MINI LCM |
Type of Device | MESH, SURGICAL, SYNTHETIC, UROGYNECOLOGIC |
Manufacturer (Section D) |
ETHICON INC. |
p.o. box 151, route 22 west |
somerville NJ 08876 |
|
MDR Report Key | 11084465 |
MDR Text Key | 224588446 |
Report Number | 2210968-2020-10356 |
Device Sequence Number | 1 |
Product Code |
OTN
|
UDI-Device Identifier | 10705031062368 |
UDI-Public | 10705031062368 |
Combination Product (y/n) | N |
PMA/PMN Number | K100936 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
other |
Type of Report
| Initial,Followup |
Report Date |
12/22/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 01/31/2013 |
Device Model Number | TVTOML |
Device Catalogue Number | TVTOML |
Device Lot Number | 3592197 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
12/21/2020
|
Initial Date FDA Received | 12/28/2020 |
Supplement Dates Manufacturer Received | 01/05/2021
|
Supplement Dates FDA Received | 01/14/2021
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 47 YR |
|
|