MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a other report with the FDA on 2020-03-13 for ALTIS SINGLE INCISION SLING SYSTEM 5196502400 519650 manufactured by Coloplast A/s.
[183336434]
(b)(4). Coloplast has not been provided any corroborating evidence to verify the information contained in this report.
Patient Sequence No: 1, Text Type: N, H10
[183336435]
As reported to coloplast though not verified, the patient's legal representative stated patient suffered serious bodily injuries, including but not limited to, foreign body reaction, mesh protrusion, mesh erosion, pelvic pain, bowel problems, urinary problems and other injuries. Per the report, the patient experienced significant mental and physical pain and suffering, disability, impairment, loss of enjoyment of life and sustained permanent injury. The patient has undergone medical treatment.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2125050-2020-00224 |
| MDR Report Key | 9831080 |
| Report Source | OTHER |
| Date Received | 2020-03-13 |
| Date of Report | 2020-03-10 |
| Date Mfgr Received | 2020-02-12 |
| Date Added to Maude | 2020-03-13 |
| 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 | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | STEPHANIE PERRYMAN |
| Manufacturer Street | 1601 WEST RIVER ROAD NORTH |
| Manufacturer City | MINNEAPOLIS, MN |
| Manufacturer Country | US |
| Manufacturer G1 | COLOPLAST MANUFACTURING US, LLC |
| Manufacturer Street | 1601 WEST RIVER ROAD NORTH |
| Manufacturer City | MINNEAPOLIS, MN |
| Manufacturer Country | US |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ALTIS SINGLE INCISION SLING SYSTEM |
| Generic Name | SURGICAL MESH |
| Product Code | PAH |
| Date Received | 2020-03-13 |
| Model Number | 5196502400 |
| Catalog Number | 519650 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | COLOPLAST A/S |
| Manufacturer Address | HOLTEDAM 1 HUMLEBAEK, 3050 DA 3050 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other; 2. Required No Informationntervention; 3. Deathisabilit | 2020-03-13 |