MAUDE Adverse Event Report: SOFRADIM PRODUCTION SAS SYMBOTEX; MESH, SURGICAL, POLYMERIC

Model Number	SYM2012E
Medical Device Problem Codes	Migration or Expulsion of Device (1395); Adverse Event Without Identified Device or Use Problem (2993); Patient Device Interaction Problem (4001)
Health Effect - Clinical Codes	Abscess (1690); Adhesion(s) (1695); Bacterial Infection (1735); Erosion (1750); Fistula (1862); Unspecified Infection (1930); Inflammation (1932); Pain (1994); Perforation (2001); Seroma (2069); Hernia (2240); Impaired Healing (2378); Obstruction/Occlusion (2422); Fluid Discharge (2686); Unspecified Tissue Injury (4559); Appropriate Clinical Signs, Symptoms and Conditions Term/Code Not Available (4581)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).Concomitant product: securestrap absorbable fixation device, product id: strap25 (lot# pl5536).If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
The patient¿s attorney alleged a deficiency against the device.The product was used for laparoscopic therapeutic treatment of an incisional hernia.It was reported that after the implant, the patient experienced recurrence, seroma, abscess, infection, mesh migration, mesh erosion, fistula, open wound, mixed bacteria flora, enterococcus faecalis, full thickness injury to colon, draining abdominal wound, induration, infected mesh, and adhesions.Post-operative patient treatment included lysis of adhesions, removal of mesh, wound vac, repair of colotomy, drainage of abdominal wound abscess, hernia sac resected, and hernia repair with new mesh.
Additional Manufacturer Narrative
Additional information: b5, b7, g1(manufacturer name, first name, last name, street 1, city, region, postal code, email, phone), h6(patient code) medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.A good faith effort will be made to obtain the applicable information relevant to the report.If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
The patient¿s attorney alleged a deficiency against the device.The product was used for laparoscopic therapeutic treatment of an incisional hernia.It was reported that after the implant, the patient experienced recurrence, seroma, abscess, infection, mesh migration, mesh erosion, fistula, open wound, mixed bacteria flora, enterococcus faecalis, full thickness injury to colon, draining abdominal wound, induration, infected mesh, adhesions, perforation, inflammation, wound debridement, and bacterial infection.Post-operative patient treatment included lysis of adhesions, removal of mesh, wound vac, repair of colotomy, drainage of abdominal wound abscess, hernia sac resected, hernia repair with new mesh, wound debridement, french and blake drain use, and medication.Concomitant device: securestrap absorbable fixation device (product id: strap25, lot number: pl5536) relevant tests/laboratory data: (b)(6) 2020: wound culture + for many white blood cells, mixed bacteria flora, enterococcus faecalis.
Event or Problem Description
The patient¿s attorney alleged a deficiency against the device.The product was used for laparoscopic therapeutic treatment of an incisional hernia.It was reported that after the implant, the patient experienced recurrence, seroma, abscess, infection, mesh migration, mesh erosion, fistula, open wound, mixed bacteria flora, enterococcus faecalis, full thickness injury to colon, draining abdominal wound, induration, infected mesh, adhesions, perforation, inflammation, bacterial infection, bowel obstruction, <(>&<)> pain.Post-operative patient treatment included lysis of adhesions, mesh revision, removal of mesh, wound vac, repair of colotomy, drainage of abdominal wound abscess, hernia sac resected, hernia repair with new mesh, wound debridement, french and blake drain use, medication, wound debridement.
Additional Manufacturer Narrative
Additional info: b5, b7, d4 (unique identifier (udi) #), g1, h6 (patient codes) medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.

• Brand Name: SYMBOTEX
• Common Device Name: MESH, SURGICAL, POLYMERIC
• Manufacturer (Section D): SOFRADIM PRODUCTION SAS; 116 avenue du formans; trevoux 01600 ; FR 01600
• Manufacturer (Section G): SOFRADIM PRODUCTION SAS; 116 avenue du formans; trevoux 01600 ; FR 01600
• Manufacturer Contact: mike bocchino ; 5920 longbow drive; 8200 coral sea st ne; mounds view,mn, CO 55112--439 ; 8006464633
• MDR Report Key: 12247586
• Report Number: 9615742-2021-01839
• Device Sequence Number: 2795982
• Product Code: FTL
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: K142908
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2020
• Device Explanted Year: 2020
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 07/08/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 01/31/2023
• Device Model Number: SYM2012E
• Device Catalogue Number: SYM2012E
• Device Lot Number: PSB0445X
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/14/2021
• Supplement Date Received by Manufacturer: 09/14/2022; 07/01/2026
• Initial Report FDA Received Date: 07/29/2021
• Supplement Report FDA Received Date: 09/20/2022; 07/08/2026
• Date Device Manufactured: 02/20/2018
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SEE SECTION H10
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 59 YR
• Patient Sex: Female
• Patient Weight: 180 LB