MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2019-11-29 for MENTOR MEMORYGEL BREAST IMPLANT 3504004BC manufactured by Mentor Texas.
Report Number | 1645337-2019-24734 |
MDR Report Key | 9392082 |
Report Source | HEALTH PROFESSIONAL |
Date Received | 2019-11-29 |
Date of Report | 2019-11-07 |
Date of Event | 2019-11-01 |
Date Mfgr Received | 2019-11-27 |
Device Manufacturer Date | 2012-11-29 |
Date Added to Maude | 2019-11-29 |
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 | MR. GABRIEL ALFAGEME |
Manufacturer Street | 3041 SKYWAY CIRCLE NORTH |
Manufacturer City | IRVING TX 75038 |
Manufacturer Country | US |
Manufacturer Postal | 75038 |
Manufacturer Phone | 949789-868 |
Manufacturer G1 | MENTOR TEXAS |
Manufacturer Street | 3041 SKYWAY CIRCLE NORTH |
Manufacturer City | IRVING TX 75038 |
Manufacturer Country | US |
Manufacturer Postal Code | 75038 |
Single Use | 3 |
Previous Use Code | 3 |
Event Type | 3 |
Type of Report | 3 |
Brand Name | MENTOR MEMORYGEL BREAST IMPLANT |
Generic Name | PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED |
Product Code | FTR |
Date Received | 2019-11-29 |
Catalog Number | 3504004BC |
Lot Number | 6656416 |
Device Expiration Date | 2017-11-30 |
Operator | HEALTH PROFESSIONAL |
Device Availability | * |
Device Eval'ed by Mfgr | N |
Device Sequence No | 1 |
Device Event Key | 0 |
Manufacturer | MENTOR TEXAS |
Manufacturer Address | 3041 SKYWAY CIRCLE NORTH IRVING TX 75038 US 75038 |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 1. Required No Informationntervention | 2019-11-29 |