MAUDE MDR 6355957

MDR report key
6355957
Report number
3011215095-2017-00925
Event key
0
Event type
3
Date of event
2017-01-01
Date received
2017-02-24
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
3

Manufacturer Contact#

Contact
MS OSSIE MILANOV
Address
1 HANAGAR ST. HOD HASHARON, 45013 IS
Phone
979-979-9799
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PREPEXPREPEXCIRC MEDTECHHFXR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-02-240

Event Narratives#

N

Patient 1

DEVICE DISPLACEMENT OR DISLODGEMENT WILL OCCUR WHEN PATIENT MOVES THE DEVICE IN SOME MANNER CONTRARY TO INSTRUCTIONS AND COUNSELING GIVEN ON THE DAY OF PLACEMENT. THE INFORMATION AS TO HOW THE EVENT OCCURRED IS OFTEN UNAVAILABLE. NO MANUFACTURER INVESTIGATION WAS UNDERTAKEN SINCE THIS WAS A FORESEEN RISK IN DEVICE USAGE AND IS CLEARLY NOTED BOTH IN THE IFU AND THE TRAINING PROGRAM. WE HAVE ATTACHED A COPY OF THE IFU WITH THE RELEVANT TEXT HIGHLIGHTED.

D

Patient 1

DEVICE DISLODGEMENT, REASON UNKNOWN, LEADING TO EDEMA, PATIENT WAS REFERRED TO SURGICAL CIRCUMCISION.