MAUDE Adverse Event Report: TEPHA, INC. - 3005670760 GALAFLEX 3D; ABSORBABLE MESH

Model Number	100042-04
Medical Device Problem Code	Patient-Device Incompatibility (2682)
Health Effect - Clinical Codes	Wound Dehiscence (1154); Necrosis (1971); Impaired Healing (2378)
Date of Event	06/19/2017
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Based on the information available, no conclusions can be made.As reported the patient experienced delayed wound healing, necrosis and wound dehiscence post implant of galaflex 3d.Medical affairs has assessed the aes as being likely related to the device and serious.Review of the device history records confirms the device was manufactured to specification.Wound dehiscence is a known inherent risk of the surgery/use and listed as a possible complication in the adverse reaction section of the instruction for use (ifu) supplied with the device.Note: this mdr report is related to a retrospective study conducted to proactively gather real-world evidence on the use and safety of the p4hb product family, including galaflex scaffold, galaflex 3d, and galaflex 3dr.All safety events from the study are adjudicated by the bd medical monitor for an independent assessment of severity and relatedness.In an abundance of caution, events for which relatedness cannot be ruled out are processed for mdr reporting.
Event or Problem Description
Per clinical trial (b)(4): on (b)(6) 2017, patient underwent bilateral revision augmentation mastopexy using a full vertical and horizontal t incision.Two pieces of galashape (galaflex 3d) were used.Concomitant procedures were liposuction to love handles and abdomen.On (b)(6) 2017, delayed wound healing and necrosis of bilateral breasts was reported.Patient had bilateral breast wound debridement for full thickness tissue loss on (b)(6) 2017.Patient was treated with medication (silvadene, hydrocortisone cream).Delayed wound healing resolved with sequelae on (b)(6) 2017.Necrosis resolved with sequelae on an unknown date.Wounds healed slowly.On (b)(6) 2017, bilateral breast wound dehiscence was reported.Patient was treated with medication (hydrocortisone cream).Resolved with sequelae on (b)(6) 2017.Review by medical affairs identifies the reported delayed wound healing, necrosis and wound dehiscence are likely related to the device and serious.

• Brand Name: GALAFLEX 3D
• Common Device Name: ABSORBABLE MESH
• Manufacturer (Section D): TEPHA, INC. - 3005670760; 99 hayden ave suite 360; lexington MA 02421
• Manufacturer (Section G): TEPHA, INC. - 3005670760; 99 hayden ave suite 360; lexington MA 02421
• Manufacturer Contact: andrew topoulos ; 100 crossings blvd.; warwick, RI 02886 ; 8005566756
• MDR Report Key: 15713376
• Report Number: 1213643-2022-00687
• Device Sequence Number: 6600919
• Product Code: OOD
• UDI-Device Identifier: 00855920006171
• UDI-Public: (01)00855920006171
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K161092
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: Other,Study
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 10/18/2022

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?: No
• Operator of Device: Health Professional
• Device Expiration Date: 10/07/2017
• Device Model Number: 100042-04
• Device Catalogue Number: SH3D04
• Device Lot Number: 170120
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 10/13/2022
• Initial Report FDA Received Date: 11/02/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 04/27/2017
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 50 YR
• Patient Sex: Female
• Patient Weight: 68 KG