MAUDE MDR 9904556

MDR report key
9904556
Report number
1645337-2020-05082
Event key
0
Event type
3
Date of event
2019-09-10
Date received
2020-03-31
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MR. GABRIEL ALFAGEME
Address
3041 SKYWAY CIRCLE NORTH IRVING TX 75038 US
Phone
949-949-9497
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1UNKNOWN TISSUE EXPANDERSEXPANDER, SKIN, INFLATABLEMENTOR TEXASLCJUNK_TISSUE EXPANDERSN N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-03-3101. O

Event Narratives#

N

Patient 1

AT THE TIME OF THIS REPORT, MENTOR HAS RECEIVED NO INFORMATION REGARDING EXPLANTATION OR AN EXPECTED EXPLANTATION DATE. IT IS UNKNOWN AT THIS TIME IF THE DEVICE WILL BE MADE AVAILABLE FOR RETURN. AS A RESULT, NO PRODUCT FAILURE ANALYSIS CAN BE CONDUCTED, AND NO DETERMINATION OF POSSIBLE CONTRIBUTING FACTORS CAN BE MADE. AS SUCH, THE INVESTIGATION WILL BE CLOSED. IF THE COMPLAINT DEVICE IS RECEIVED IN THE FUTURE, THE INVESTIGATION WILL BE REOPENED AND CONDUCTED AS APPROPRIATE. SINCE NO LOT NUMBER WAS PROVIDED, NO MANUFACTURING RECORD EVALUATION REVIEW COULD BE PERFORMED. REASON FOR DEVICE EXPLANT AND/OR REOPERATION: N/A. MANUFACTURER?S REFERENCE NUMBER: (B)(4).

D

Patient 1

A HEALTH CARE PROVIDER HAS REPORTED THAT FIVE PATIENTS WHO UNDERWENT BREAST RECONSTRUCTION EXPERIENCED TISSUE EXPANDER DEFLATION OVER THE PAST THREE TO SIX MONTHS. THE PHYSICIAN STATED THAT EITHER THE BACK OR PORT OF THESE EXPANDERS BLEW OUT. NO ADDITIONAL DETAILS AS TO THE NATURE OF THESE DEFLATIONS WERE MADE AVAILABLE. AT THE TIME OF THIS REPORT, MENTOR HAS RECEIVED NO INFORMATION REGARDING EXPLANTATION OR AN EXPECTED EXPLANTATION DATE. THESE DEFLATIONS ARE BEING REPORTED INDIVIDUALLY IN SEPARATE REPORTS. IF ADDITIONAL DETAILS ARE MADE AVAILABLE, THEN A SUPPLEMENTAL REPORT WILL BE SUBMITTED.