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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ETHICON INC. PROCEED MESH 6INX6IN(15CMX15CM) SQ MESH, SURGICAL, POLYMERIC

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ETHICON INC. PROCEED MESH 6INX6IN(15CMX15CM) SQ MESH, SURGICAL, POLYMERIC Back to Search Results
Model Number PCDM1
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Diarrhea (1811); Nausea (1970); Chills (2191)
Event Type  Injury  
Manufacturer Narrative

(b)(4). To date, the device has not been returned. If the product is returned for evaluation, any further information derived from the evaluation will be submitted in a supplemental 3500a form. (b)(4) submitted for adverse event which occurred on (b)(6) 2010. (b)(4) submitted for adverse event which occurred on (b)(6) 2011.

 
Event Description

It was reported by an attorney that the patient underwent hernia repair surgery on (b)(6) 2009 and mesh was implanted. It was reported that the patient underwent removal surgery on (b)(6) 2010 during which the surgeon noted loops of small bowel rotated into and adhesed to the mesh. The small bowel was not salvageable and small bowel resection was required. The small bowel and mesh were removed. It was reported that the patient underwent recurrent hernia repair surgery on 8/15/2011 and mesh was implanted. It was reported that the patient experienced severe pain, nausea, diarrhea, chills, inflammation, loss of appetite, and extreme weight loss. Other procedure is captured under separate file. No additional information was provided.

 
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Brand NamePROCEED MESH 6INX6IN(15CMX15CM) SQ
Type of DeviceMESH, SURGICAL, POLYMERIC
Manufacturer (Section D)
ETHICON INC.
1000 route 202
raritan NJ 08876
Manufacturer (Section G)
ETHICON INC.-CORNELIA
655 ethicon circle
cornelia GA 30531
Manufacturer Contact
elba bello
p.o. box 151, route 22 west
somerville, NJ 08876
9082182213
MDR Report Key11031687
MDR Text Key222328833
Report Number2210968-2020-10051
Device Sequence Number1
Product Code FTL
Combination Product (Y/N)N
Reporter Country CodeUS
PMA/PMN NumberK060713
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type OTHER
Reporter Occupation
Type of Report Initial,Followup
Report Date 12/11/2020
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received12/17/2020
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? No
Device Operator HEALTH PROFESSIONAL
Device MODEL NumberPCDM1
Device Catalogue NumberPCDM1
Was Device Available For Evaluation? No
Is The Reporter A Health Professional? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received06/14/2021
Was Device Evaluated By Manufacturer? Device Not Returned To Manufacturer
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: 12/17/2020 Patient Sequence Number: 1
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