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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ATRIUM MEDICAL CORPORATION MESH C-QUR LITE CENTRIFX MESH, SURGICAL, POLYMERIC
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ATRIUM MEDICAL CORPORATION MESH C-QUR LITE CENTRIFX MESH, SURGICAL, POLYMERIC Back to Search Results
Model Number 31395
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Pain (1994); Scarring (2061)
Event Type  Injury  
Manufacturer Narrative

Investigation: based on the review of the device history records and product complaint details atrium can find no fault with the product. This lot of mesh passed all quality and performance requirement.

 
Event Description

This event is deemed reportable based on the allegations in a potential lawsuit which, while unsubstantiated, suggest that a reportable event may have occurred during use of an atrium medical mesh product. Plaintiff allegedly experienced pain, scarring, torn labrum, herniated disc, and additional medical procedures as a result of the implantation of the mesh implant.

 
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Brand NameMESH C-QUR LITE CENTRIFX
Type of DeviceMESH, SURGICAL, POLYMERIC
Manufacturer (Section D)
ATRIUM MEDICAL CORPORATION
40 continental blvd
merrimack NH
Manufacturer (Section G)
ATRIUM MEDICAL CORPORATION
40 continental blvd
merrimack NH
Manufacturer Contact
40 continental blvd
merrimack, NH 
MDR Report Key10941508
MDR Text Key219382662
Report Number3011175548-2020-01400
Device Sequence Number1
Product Code FTL
Combination Product (Y/N)N
PMA/PMN NumberK110110
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type OTHER
Type of Report Initial
Report Date 12/03/2020
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received12/03/2020
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? No
Device Operator HEALTH PROFESSIONAL
Device EXPIRATION Date02/01/2018
Device MODEL Number31395
Device Catalogue Number31395
Device LOT Number404247
Was Device Available For Evaluation? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received11/16/2020
Was Device Evaluated By Manufacturer? No
Date Device Manufactured02/17/2016
Is The Device Single Use? Yes
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient TREATMENT DATA
Date Received: 12/03/2020 Patient Sequence Number: 1
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