MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2018-11-05 for NATRELLE INSPIRA MODPROF 485CC SIZER US MSZ-M485 manufactured by Allergan (costa Rica).
[126178555]
A review of the device history record has been completed. No deviations or non-conformances noted. Further information from the reporter regarding event, product, or patient details has been requested. No additional information is available at this time. Device labeling: re-sterilizable breast implant sizers are intended to be used only by a qualified surgeon. Before proceeding with surgery, the surgeon should inform the patient of the following warnings. Re-sterilizable sizers are temporary devices, and are not intended to be used as a permanent implant. They should only be used for temporary intra-operative placement, to assist the surgeon in permanent implant size selection.
Patient Sequence No: 1, Text Type: N, H10
[126178556]
Healthcare provider reported left side "sizer was implanted on accident. " device remains implanted.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9617229-2018-08836 |
| MDR Report Key | 8039673 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2018-11-05 |
| Date of Report | 2018-11-05 |
| Date of Event | 2018-08-03 |
| Date Mfgr Received | 2018-08-29 |
| Device Manufacturer Date | 2018-05-28 |
| Date Added to Maude | 2018-11-05 |
| 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 | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. SUZANNE WOJCIK |
| Manufacturer Street | 301 W HOWARD LANE SUITE 100 |
| Manufacturer City | AUSTIN TX 78753 |
| Manufacturer Country | US |
| Manufacturer Postal | 78753 |
| Manufacturer Phone | 7372473605 |
| Manufacturer G1 | ALLERGAN (COSTA RICA) |
| Manufacturer Street | 900 PARKWAY GLOBAL PARK ZONA FRANCA |
| Manufacturer Country | CS |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | NATRELLE INSPIRA MODPROF 485CC SIZER US |
| Generic Name | SIZER, MAMMARY, BREAST IMPLANT VOLUME |
| Product Code | MRD |
| Date Received | 2018-11-05 |
| Catalog Number | MSZ-M485 |
| Lot Number | 3207956 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ALLERGAN (COSTA RICA) |
| Manufacturer Address | 900 PARKWAY GLOBAL PARK ZONA FRANCA CS |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2018-11-05 |