Brand Name | PHYSIOMESH |
Type of Device | MESH, SURGICAL |
Manufacturer (Section D) |
ETHICON INC. |
p.o. box 151, route 22 west |
somerville 08876 0151 |
|
Manufacturer (Section G) |
ETHICON INC.-GMBH |
p.o. box 1409 |
|
norderstedt D2284 1 |
GM
D22841
|
|
Manufacturer Contact |
darlene
kyle
|
p.o. box 151, route 22 west |
somerville 08876-0151
|
9082182792
|
|
MDR Report Key | 7138769 |
MDR Text Key | 95512626 |
Report Number | 2210968-2017-71848 |
Device Sequence Number | 1 |
Product Code |
FTL
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K093932 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
other |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup,Followup |
Report Date |
06/25/2019 |
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
|
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
12/07/2017 |
Initial Date FDA Received | 12/21/2017 |
Supplement Dates Manufacturer Received | 03/05/2018 06/25/2019
|
Supplement Dates FDA Received | 03/29/2018 07/02/2019
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 34 YR |
Patient Weight | 172 |
|
|