MAUDE Adverse Event Report: ETHICON PHYSIOMESH FLEXIBLE COMPOSITE MESH

Model Number PHY1015

Device Problems Nonstandard Device (1420); Device Operates Differently Than Expected (2913)

Patient Problem Therapeutic Effects, Unexpected (2099)

Event Date 12/28/2011

Event Type  malfunction  

Event Description

Original hernia repair conducted with product that has now voluntarily been recalled by the manufacturer due to greater than expected recurrence/operative rates.Pt required a second procedure due to recurrent hernia.

• Brand Name: PHYSIOMESH FLEXIBLE COMPOSITE MESH
• Type of Device: PHYSIOMESH FLEXIBLE COMPOSITE MESH
• Manufacturer (Section D): ETHICON; somerville NJ 08876
• MDR Report Key: 5754548
• MDR Text Key: 48444563
• Report Number: MW5063088
• Device Sequence Number: 1
• Product Code: FTL
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Voluntary
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 06/23/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 06/23/2016
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 08/01/2013
• Device Model Number: PHY1015
• Device Lot Number: DK8KGA0RH
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: N
• Patient Sequence Number: 1
• Patient Age: 29 YR
• Patient Weight: 107