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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MENTOR TEXAS MENTOR SALINE SMOOTH ROUND MODERATE PROFILE IMPLANTS BREAST IMPLANT

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MENTOR TEXAS MENTOR SALINE SMOOTH ROUND MODERATE PROFILE IMPLANTS BREAST IMPLANT Back to Search Results
Catalog Number 350-1640
Device Problem Device Contamination with Chemical or Other Material (2944)
Patient Problem No Code Available (3191)
Event Date 01/21/2017
Event Type  Injury  
Manufacturer Narrative
An attempt was made to submit this report on 09/20/2017. However, due to an outage affecting the esg or the cdrh emdr processing system we were unable to meet the report submission due date. (b)(4).
 
Manufacturer Narrative
This supplemental report is to provide dhr. The device history record (dhr) of lot number 223220 was reviewed and no anomalies were found related to this complaint. In addition, the dhr review verifies that the device was manufactured in accordance with documented specification and procedures. (b)(4).
 
Manufacturer Narrative
Device investigation summary: since the product was not returned for analysis, no product failure analysis can be conducted, and no determination of possible contributing factors could be made. Manufacturing controls: the manufacturing process (from shell fabrication to secondary packaging) was reviewed for foreign matter/ particulate control at mentor irving cmes (controlled manufacturing environment) which includes shell fabrication, main assembly, primary packaging areas, gamma sterilization, and secondary packaging areas. At multiple points of the manufacturing process, devices within the lot are processed to ensure any foreign matter, particulates or contaminants are removed or 100% visually inspected for any defects including foreign matter or particulates and subsequently rejected when identified. All manufacturing areas where the shell or device is exposed to environment is a controlled manufacturing environment (cme). Gowning is required and strictly enforced for all individuals entering designated controlled manufacturing environments (cme) at mentor, whether they are mentor employees, visitors or contractors. The cme garments consist of hair coverings (bouffant and/or hood), frock or jumpsuit, and shoe or boot covers. Sterilization records were also reviewed for product code 350-1640, lot# 223220. Environmental monitoring for viable airborne particulates and surface microbials is routinely performed in each controlled manufacturing environment (cme) on a weekly basis. Review of the environmental monitoring data for viable airborne particulates and surface microbials during the manufacturing of product code 350-1640, lot# 223220 identified all acceptable results in order to release the lot. Non-viable particulates are measured on a quarterly basis. Review of the non-viable particulates data for q204 and q304 (periods before and after the manufacture of product code 350-1640, lot# 223220) were reviewed and no excursions were identified. A root cause failure analysis will not be conducted since the investigation could not confirm that an actual failure of the device to conform to expected performance had occurred. Infection, manifested by swelling, tenderness, pain and fever, may appear in the immediate postoperative period or at any time after insertion of the implant. Infection is a known complication associated with any surgery. The application failure modes and effects analysis (afmea) was reviewed for the defect in question (foreign matter/mold) with hazard risk was determined to be as low as possible (alap), with no further action required. If the complaint device is received in the future, the complaint will be re-opened and additional investigation will be completed. Manufacturer¿s reference number: (b)(4).
 
Manufacturer Narrative
No device was received for analysis at the time of submission of the initial 3500a. Since the product was not returned for analysis, no product failure analysis can be conducted and no determination of possible contributing factors could be made. The device history record (dhr) review is in progress. Once completed, the information will be submitted in a supplemental. This complaint is related to the other mdr for the other implant on the same patient: (b)(4). Manufacturer's ref. No: (b)(4).
 
Event Description
It was reported that a female patient (age: unk) underwent a breast cosmetic surgery with mentor saline implants in (b)(6) 2001. Recently she had implants explantation for unknown reason. During explantation, the physician observed mold in devices. No further information is available at present.
 
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Brand NameMENTOR SALINE SMOOTH ROUND MODERATE PROFILE IMPLANTS
Type of DeviceBREAST IMPLANT
Manufacturer (Section D)
MENTOR TEXAS
3041 skyway circle north
irving TX 75038
Manufacturer Contact
joaquin kurz
3041 skyway circle north
irving, TX 75038
650687-492
MDR Report Key6884038
MDR Text Key109264301
Report Number1645337-2017-00108
Device Sequence Number1
Product Code FWM
Combination Product (y/n)N
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type consumer
Reporter Occupation
Type of Report Initial,Followup,Followup,Followup
Report Date 08/21/2017
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received09/21/2017
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Device Operator
Device Expiration Date02/15/2005
Device Catalogue Number350-1640
Device Lot Number223220
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received02/28/2019
Was Device Evaluated by Manufacturer? No
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Unkown

Patient Treatment Data
Date Received: 09/21/2017 Patient Sequence Number: 1
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