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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MENTOR TEXAS UNKNOWN SALINE IMPLANTS; PROSTHESIS, BREAST, INFLATABLE, INTERNAL, SALINE

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MENTOR TEXAS UNKNOWN SALINE IMPLANTS; PROSTHESIS, BREAST, INFLATABLE, INTERNAL, SALINE Back to Search Results
Catalog Number UNKNOWN SALINE IMPLANTS
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Capsular Contracture (1761); Unspecified Infection (1930); No Code Available (3191)
Event Date 02/01/2015
Event Type  Injury  
Manufacturer Narrative
Since the device has not been returned for analysis, no product failure analysis can be conducted, and no determination of possible contributing factors can be made.As such, the investigation will be closed.If the complaint device is received in the future, the investigation will be reopened and conducted as appropriate.Since no lot number was provided, no device history record (dhr) review could be performed.Manufacturer¿s reference number: (b)(4).
 
Event Description
It was reported that a (b)(6) caucasian female patient who underwent primary breast augmentation on (b)(6) 2009 developed bilateral baker grade unknown capsular contracture.The patient also had low white blood count, positive ana, elevated monocyte level (13%), full body inflammation, massive weight gain, brain fog, tinnitus, major fatigue, memory loss, new onset allergies, skin condition on the knees, rashes, knee/shoulder throbbing, inflamed joints, painful breasts, and hand and "wet" swelling.The patient reported that her blood is "screaming disease and infection." the patient underwent testing but everything returned negative for disease.No product issue, such as rupture, was reported.The root cause of the patient's symptoms are unclear.The patient underwent removal without replacement on (b)(6) 2018.This report is for "the" one of the two implant.
 
Manufacturer Narrative
On (b)(6) 2019, mentor became aware that this report is a duplicate of manufacturer¿s report number 1645337-2019-09953.This file has been updated to contain the most current and accurate information, and all subsequent regulatory reporting, if applicable, will take place under this report number.The full details of our investigation are below: it was reported that a 31-year-old caucasian female patient underwent primary breast augmentation with two unspecified mentor saline breast implants and suffered bilateral capsular contracture postoperatively.The patient also reported directly to fda via mw5079602 a series of unexplained systemic symptoms, including low white blood cell count, positive ana, elevated monocyte level (13%), full body inflammation, massive weight gain, brain fog, tinnitus, major fatigue, memory loss, new onset allergies, skin condition on the knees, rashes, knee/shoulder throbbing, inflamed joints, painful breasts, and wet/swollen hands.She states in mw5079602 that she believed she had an infection as well.The patient¿s tests returned normal results.On (b)(6) 2018, she underwent bilateral explantation without removal.No device issue, such as rupture, was reported.Upon explantation, the devices were in ¿grossly normal¿ condition, per the patient¿s physician.Reason for device explant and/or reoperation: generalized illness and capsular contracture manufacturer's reference number: (b)(4).
 
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Brand Name
UNKNOWN SALINE IMPLANTS
Type of Device
PROSTHESIS, BREAST, INFLATABLE, INTERNAL, SALINE
Manufacturer (Section D)
MENTOR TEXAS
3041 skyway circle north
irving TX 75038
MDR Report Key7999163
MDR Text Key124810791
Report Number1645337-2018-06297
Device Sequence Number1
Product Code FWM
Combination Product (y/n)N
PMA/PMN Number
UNK
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type consumer
Type of Report Initial,Followup
Report Date 09/28/2018
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received10/24/2018
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator Health Professional
Device Catalogue NumberUNKNOWN SALINE IMPLANTS
Was Device Available for Evaluation? No
Date Manufacturer Received08/21/2019
Patient Sequence Number1
Patient Outcome(s) Life Threatening; Required Intervention; Disability;
Patient Age31 YR
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