| 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
|
| 8200 coral sea st ne |
| mounds view, MN 55112--439
|
|
+1(800)646-4633
|
|
| MDR Report Key | 50938585 |
| Report Number | 9615742-2026-00846 |
| Device Sequence Number | 13450874 |
| Product Code |
FTL
|
| UDI-Device Identifier | 10884521190405 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | IN |
| PMA/510(K) Number | K142908 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Health Professional,Company Representative |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/29/2026 |
| 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? |
No
|
| Operator of Device |
Health Professional
|
| Device Expiration Date | 04/30/2026 |
| Device Model Number | SYM15F |
| Device Catalogue Number | SYM15F |
| Device Lot Number | PVE0204X |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 09/07/2026 |
| Initial Report FDA Received Date | 09/29/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 11/30/2020 |
| 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;
Hospitalization;
|
| Patient Age | 53 YR |
| Patient Sex | Male |