MAUDE MDR 5043323

MDR report key
5043323
Report number
3006722112-2015-00268
Event key
0
Event type
3
Date of event
2015-01-22
Date received
2015-08-31
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
LAURA LEBOEUF
Address
1120 S CAPITAL OF TEXAS HWY BULDING 1, SUITE 300 AUSTIN TX 78748 US
Phone
855-855-8555
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1LAP-BAND AP ADJUSTABLE GASTRIC BANDING SYSTEM (SMALL)IMPLANT, INTRAGASTRIC FOR MORBID OBESITYALLERGAN (COSTA RICA)LTIAB-20260NIR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-08-3101. R

Event Narratives#

N

Patient 1

TAPER II. THE REPORTER OF THE COMPLAINT WAS ASKED TO RETURN THE PRODUCT FOR ANALYSIS. THE DEVICE HAS NOT YET BEEN RECEIVED BY ALLERGAN. BASED UPON THE CATALOG NUMBER AND IMPLANT DATE PROVIDED BY THE REPORTER THE CONNECTOR TYPE IS ASSUMED TO BE A TAPER II. VISUAL EXAMINATION MAY DETERMINE THE CONNECTOR TYPE ASSOCIATED WITH THIS REPORT. ALLERGAN HAS NOT RECEIVED THE PRODUCT AT THIS TIME. THEREFORE NO ANALYSIS OR TESTING HAS BEEN DONE. ADHESION IS A SURGICAL/PHYSIOLOGICAL COMPLICATION AND ANALYSIS OF THE DEVICE GENERALLY DOES NOT ASSIST ALLERGAN IN DETERMINING A PROBABLE CAUSE FOR THIS EVENT. NO ADDITIONAL INFORMATION HAS BEEN REPORTED TO ALLERGAN REGARDING THE SERIAL NUMBER, EXPLANT DATE, DIAGNOSTIC TESTING, PATIENT DATA OR FURTHER EVENT DETAILS. DEVICE LABELING ADDRESSES THE POSSIBLE OUTCOME OF LEAKAGE AS FOLLOWS: "DEFLATION OF THE BAND MAY OCCUR DUE TO LEAKAGE FROM THE BAND, THE PORT OR THE CONNECTOR TUBING." DEVICE LABELING ADDRESSES THE POSSIBLE OUTCOME OF ADHESIONS AS FOLLOWS: "GASTRIC BANDING DONE AS A REVISION PROCEDURE HAS A GREATER RISK OF COMPLICATIONS. PRIOR ABDOMINAL SURGERY IS COMMONLY ASSOCIATED WITH ADHESIONS INVOLVING THE STOMACH. IN THE U.S. STUDY, 42% OF THE U.S. PATIENTS UNDERGOING REVISIONS WERE REPORTED TO HAVE DEVELOPED ADHESIONS INVOLVING THE STOMACH."

D

Patient 1

HEALTHCARE PROFESSIONAL REPORTED "BREAK IN TUBING NOTICED ON DAY OF REVISION", "PORT CUT OFF AS TISSUE WAS HARD TO REMOVE". THE PORT WAS REMOVED AND REPLACED.