MAUDE Adverse Event Report: ETHICON INC. PRLNE HERNIA SYSTEM MSH 7.5CM UNDERLAY; MESH, SURGICAL, POLYMERIC

Model Number PHSM

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Nerve Damage (1979); Pain (1994)

Event Type  Injury  

Manufacturer Narrative

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.Mwr-18082021-0001020548 submitted for the adverse event which occurred on (b)(6) 2018.Mwr-18082021-0001020549 submitted for the adverse event which occurred on (b)(6) 2020.

Event Description

It was reported by an attorney that the patient underwent hernia repair surgery on (b)(6) 2015 and mesh was implanted.It was reported that the patient underwent hernia repair surgery with removal of meshomas on (b)(6) 2018.It was reported that the patient underwent removal surgery, lysis of adhesions, lysis of adhesions of the mesh to cord structures, left orchiectomy and removal of spermatic cord section on (b)(6) 2020.It was reported that the patient experienced severe pain, nerve entrapment and nerve damage which resulted in orchiectomy and neurectomy.The patient had a previous mesh implanted on (b)(6) 2012 which is captured in a separate file.No additional information was provided.

Manufacturer Narrative

Date sent to the fda: 8/26/2021.A review of the batch manufacturing records was conducted and the batch met all finished goods release criteria.

• Brand Name: PRLNE HERNIA SYSTEM MSH 7.5CM UNDERLAY
• Type of Device: MESH, SURGICAL, POLYMERIC
• Manufacturer (Section D): ETHICON INC.; 1000 route 202; raritan NJ 08869
• MDR Report Key: 12345916
• MDR Text Key: 267815640
• Report Number: 2210968-2021-07533
• Device Sequence Number: 1
• Product Code: FTL
• UDI-Device Identifier: 10705031048997
• UDI-Public: 10705031048997
• Combination Product (y/n): N
• PMA/PMN Number: K180829
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: other
• Type of Report: Initial,Followup
• Report Date: 08/17/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/19/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 01/31/2020
• Device Model Number: PHSM
• Device Catalogue Number: PHSM6
• Device Lot Number: 28999J03
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 08/25/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention