MAUDE MDR 3454284

MDR report key
3454284
Report number
1018233-2013-09021
Event key
0
Event type
3
Date received
2013-11-01
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
600
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
RENE HUCKABY
Address
8195 INDUSTRIAL BLVD. COVINGTON GA 30014 US
Phone
770-770-7707
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ALIGN S SUPRPUBIC URETHRAL SUPPORT SYSTEMBARD SHANNON LIMITEDFTLNABRD200SHUWA0313R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12013-11-0101. R

Event Narratives#

D

Patient 1

THE PATIENT'S ATTORNEY ALLEGED A DEFICIENCY AGAINST THE DEVICE. ADD'L INFO HAS BEEN REQUESTED, BUT NOT YET RECEIVED.

N

Patient 1

THE SAMPLE WAS NOT RETURNED. THE FINISHED PRODUCT MET ALL SPECIFICATIONS PRIOR TO BEING RELEASED FOR GENERAL DISTRIBUTION. THE INSTRUCTIONS FOR USE WHICH ACCOMPANIES ALL DEVICES CURRENTLY ADDRESSES POTENTIAL RISKS ASSOCIATED WITH SURGICALLY IMPLANTED MATERIALS. (B)(4). "LAWYER-FILED REPORT- (B)(6)."