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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ATRIUM MEDICAL C-QUR TACSHIELD; MESH, SURGICAL, POLYMERIC

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ATRIUM MEDICAL C-QUR TACSHIELD; MESH, SURGICAL, POLYMERIC Back to Search Results
Model Number 31612
Device Problems Contamination (1120); Material Deformation (2976)
Patient Problems Abscess (1690); Adhesion(s) (1695); Bacterial Infection (1735); Purulent Discharge (1812); Failure of Implant (1924); Inflammation (1932); Pain (1994)
Event Type  Injury  
Manufacturer Narrative
We are unable to fully investigate this event as no product code, lot number, or sample was provided.
 
Event Description
This event is deemed reportable based on the allegations in a lawsuit which, while unsubstantiated, suggest that a reportable event may have occurred during use of atrium medical¿s mesh product.Allegedly, following the implant of c-qur tacshield mesh, the plaintiff experienced pain, inflammation, mesh deformation, mesh removal and recurrent hernia requiring additional surgery, infected mesh, abdominal abscess, purulent fluid surrounding the mesh, extensive adhesions, inflamed omentum causing inflammatory rind.Since this is a legal matter, the case has been turned over to legal counsel and further information obtained through investigation or discovery may fall under the attorney/client and/or work product privilege.However, atrium will supplement this report as appropriate if additional information comes to its attention.
 
Manufacturer Narrative
Investigation: based on the review of the device history and sterilization records and product complaint details atrium can find no fault with the product.This lot of mesh passed all quality and performance requirement.
 
Event Description
Allegedly the plaintiff also experienced blood loss, fibrosis, necrosis and granulomatous tissue.
 
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Brand Name
C-QUR TACSHIELD
Type of Device
MESH, SURGICAL, POLYMERIC
Manufacturer (Section D)
ATRIUM MEDICAL
40 continental blvd
merrimack NH 03054
Manufacturer (Section G)
ATRIUM MEDICAL
40 continental blvd
merrimack NH 03054
Manufacturer Contact
40 continental blvd
merrimack, NH 03054
MDR Report Key7046381
MDR Text Key92586902
Report Number3011175548-2017-00300
Device Sequence Number1
Product Code FTL
Combination Product (y/n)N
PMA/PMN Number
K100076
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type other
Reporter Occupation Other
Type of Report Initial,Followup
Report Date 11/20/2017
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
Device Operator Health Professional
Device Expiration Date09/30/2014
Device Model Number31612
Device Catalogue Number31612
Device Lot Number10792572
Other Device ID Number00650862316124
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Initial Date Manufacturer Received 11/08/2017
Initial Date FDA Received11/20/2017
Supplement Dates Manufacturer Received06/05/2018
Supplement Dates FDA Received06/14/2018
Date Device Manufactured09/28/2011
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Patient Outcome(s) Required Intervention;
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