Brand Name | PROLENE POLYPROPYLENE MESH UNKNOWN PRODUCT |
Type of Device | MESH, SURGICAL, POLYMERIC |
Manufacturer (Section D) |
ETHICON INC. |
1000 route 202 |
raritan NJ 08869 |
|
Manufacturer (Section G) |
ETHICON INC.-SAN LORENZO PR |
982 road 183 km 8.3 |
|
san lorenzo PR |
|
Manufacturer Contact |
elba
bello
|
1000 route 202 |
raritan, NJ 08869
|
9083863534
|
|
MDR Report Key | 15689942 |
MDR Text Key | 302570230 |
Report Number | 2210968-2022-08896 |
Device Sequence Number | 1 |
Product Code |
FTL
|
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | K962530 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Other,Foreign |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
10/28/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 10/28/2022 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 12/11/2022 |
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
|
Removal/Correction Number | N/A |
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
Patient Sex | Male |
|
|