MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 00,04 report with the FDA on 2013-01-03 for ELEVATE PROLAPSE REPAIR SYSTEM manufactured by American Medical Systems, Inc..
[3063644]
It was reported by the plaintiff's attorney that the plaintiff was implanted with a elevate on or about (b)(6) 2004. It was reported by the plaintiff's attorney that the plaintiff experienced emotional distress and a problem with the product. The device was implanted for treatment.
Patient Sequence No: 1, Text Type: D, B5
[10366550]
Should additional information become available regarding this event it will be re-evaluated and a follow-up report will be sent as appropriate. Lawyer-filed report-(b)(4).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2183959-2013-00003 |
| MDR Report Key | 2901106 |
| Report Source | 00,04 |
| Date Received | 2013-01-03 |
| Date of Report | 2012-11-19 |
| Date Mfgr Received | 2012-12-07 |
| Date Added to Maude | 2013-01-09 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | SHARON ZURN, DIRECTOR |
| Manufacturer Street | 10700 BREN RD., WEST |
| Manufacturer City | MINNETONKA MN 55343 |
| Manufacturer Country | US |
| Manufacturer Postal | 55343 |
| Manufacturer Phone | 9529306347 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ELEVATE PROLAPSE REPAIR SYSTEM |
| Generic Name | SURGICAL MESH |
| Product Code | OPT |
| Date Received | 2013-01-03 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | AMERICAN MEDICAL SYSTEMS, INC. |
| Manufacturer Address | 10700 BREN RD., WEST MINNETONKA MN 55343 US 55343 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Deathisabilit | 2013-01-03 |