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

Model Number	PPM4530
Medical Device Problem Codes	Material Integrity Problem (2978); Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Abdominal Pain (1685); Abscess (1690); Adhesion(s) (1695); Bacterial Infection (1735); Cellulitis (1768); Chest Pain (1776); Purulent Discharge (1812); Dyspnea (1816); Fever (1858); Hemorrhage/Blood Loss/Bleeding (1888); Inflammation (1932); Muscle Weakness/Atrophy (1967); Necrosis (1971); Pain (1994); Pneumonia (2011); Seroma (2069); Chills (2191); Dizziness (2194); Discomfort (2330); Ascites (2596); Abdominal Distention (2601); Fluid Discharge (2686); Embolism/Embolus (4438); Thrombosis/Thrombus (4440); Sexual Dysfunction (4510); Nodule (4551); Unspecified Tissue Injury (4559); Swelling/ Edema (4577); Appropriate Clinical Signs, Symptoms and Conditions Term/Code Not Available (4581)
Type of Reportable Event	Serious Injury
Event or Problem Description
The patient¿s attorney alleged a deficiency against the device.The product was used for therapeutic treatment of incisional hernia.It was reported that after implant, the patient experienced necrotic tissue, hard mass, inflammation, drainage, seroma, abscess, adhesions, mesh shrinkage, and pain.Post-operative patient treatment included revision surgery, mesh partially removed, abscess incision and drainage surgery.
Additional Manufacturer Narrative
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 therapeutic treatment of an incisional hernia.It was reported that after overlay implant, the patient experienced dvt, fluid collection, saddle embolism, blood clot, pneumonia, right heart strain, abnormal troponin, bnp, d-dimer, diastolic dysfunction, elevated rsvp, gas collection, growth of serratia marcescens, staphylococcus aureus, pseudomonas aeruginosa, serosanguinous drainage, shortness of breath, acute pe, chest pain, fever, difficulty standing up straight and moving without pain, abdominal pain, firmness in abdomen, blood loss, serosanguinous drainage, brownish fluid output, cellulitis, swelling, unable to have sex due to pain, induration, tenderness, weakness, dizziness, hemorrhage, chills, creamy drainage, green drainage, uncontrolled blood sugars, necrotic tissue, hard mass, inflammation, drainage, seroma, abscess, adhesions, mesh shrinkage, and pain.Post-operative patient treatment included ct scan, ultrasound, jp drains, pca pump, physical therapy, iv fluids, medication, supplemental oxygen, home health services, procedure for fluid collection, catheter exchange under fluoroscopic guidance, home oxygen, anticoagulation treatment, use of keflex, iv antibiotics, pain medication, wound care, wearing abdominal binder, wound washout, betadine soaked packing, hospitalization, revision surgery, mesh partially removed, abscess incis ion and drainage surgery.
Additional Manufacturer Narrative
Additional info: a5a, b2 (added hospitalization and disability), h6 (patient codes, imf codes, ime e2402: "right heart strain, abnormal troponin, bnp, and d-dimer, diastolic dysfunction, elevated rsvp, serratia marcescens, pseudomonas aeruginosa, cannot have sex, induration, uncontrolled blood sugars, mass").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.

• Brand Name: PARIETENE
• 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: justin ellis ; 8200 coral sea st ne; mounds view, MN 55112 ; 7635265677
• MDR Report Key: 16287222
• Report Number: 9615742-2023-00122
• Device Sequence Number: 20144130
• Product Code: FTL
• UDI-Device Identifier: 10884521213791
• UDI-Public: 10884521213791
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: K142091
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 03/03/2023

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: 08/31/2024
• Device Model Number: PPM4530
• Device Catalogue Number: PPM4530
• Device Lot Number: STH1714X
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/01/2023
• Supplement Date Received by Manufacturer: 02/22/2023
• Initial Report FDA Received Date: 02/02/2023
• Supplement Report FDA Received Date: 03/03/2023
• Date Device Manufactured: 09/12/2019
• 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: Disability; Required Intervention; Hospitalization
• Patient Sex: Male
• Patient Weight: 52 KG
• Patient Ethnicity: Hispanic