Brand Name | FENIX CONTINENCE RESTORATION SYSTEM |
Type of Device | IMPLANTED FECAL INCONTINENCE DEVICE |
Manufacturer (Section D) |
TORAX MEDICAL, INC. |
4188 lexington avenue n |
shoreview MN 55126 |
|
Manufacturer (Section G) |
TORAX MEDICAL, INC. |
4188 lexington avenue north |
|
shoreview MN 55126 |
|
Manufacturer Contact |
tressa
lauer
|
4188 lexington avenue north |
shoreview, MN 55126
|
6513618900
|
|
MDR Report Key | 6674184 |
MDR Text Key | 78610713 |
Report Number | 3008766073-2017-00068 |
Device Sequence Number | 1 |
Product Code |
PMH
|
Combination Product (y/n) | N |
Reporter Country Code | UK |
PMA/PMN Number | H130006 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
11/20/2017 |
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 |
Physician
|
Device Expiration Date | 07/29/2019 |
Device Model Number | FS19 |
Device Lot Number | 8659 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 06/12/2017 |
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
05/31/2017 |
Initial Date FDA Received | 06/28/2017 |
Supplement Dates Manufacturer Received | 11/20/2017
|
Supplement Dates FDA Received | 12/18/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 07/29/2015 |
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) |
Hospitalization;
Life Threatening;
Disability;
|
Patient Age | 62 YR |