MAUDE Adverse Event Report: COVIDIEN LP LLC NORTH HAVEN SURGIPRO; MESH, SURGICAL, POLYMERIC

Model Number	SPM-149
Medical Device Problem Codes	Loss of or Failure to Bond (1068); Migration or Expulsion of Device (1395); Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Abdominal Pain (1685); Abscess (1690); Purulent Discharge (1812); Fever (1858); Unspecified Infection (1930); Injury (2348); Impaired Healing (2378); Ascites (2596); No Code Available (3191)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).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 a ventral incisional hernia.It was reported that after implant, the patient experienced abscess, infection, open wound, mesh had bunched down and withdrawn nearly 7 cm from where it had been anchored, phlegmon surrounding mesh and intraabdominal fluid, abdominal pain, fever, murky fluid, large purulent phlegmon, and mesh had bunched down around the phlegmon and withdrawn from where it had been previously anchored.Post-operative patient treatment included aspiration of subfascial abscess, wound left open with packing, complex open abdominal wound closure, explantation of infected mesh as well as incision and drainage of intraabdominal fluid consistent with abscess.

• Brand Name: SURGIPRO
• Common Device Name: MESH, SURGICAL, POLYMERIC
• Manufacturer (Section D): COVIDIEN LP LLC NORTH HAVEN; 195 mcdermott rd; north haven CT 06473
• MDR Report Key: 8987470
• Report Number: 1219930-2019-05134
• Device Sequence Number: 14169950
• Product Code: FTL
• UDI-Device Identifier: 10884521101333
• UDI-Public: 10884521101333
• Combination Product (Y/N): N
• Initial Reporter State: NY
• Initial Reporter Country: US
• PMA/510(K) Number: K915526
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2014
• Device Explanted Year: 2015
• Reporter Type: Manufacturer
• Report Source: consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 09/11/2019

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 03/31/2016
• Device Model Number: SPM-149
• Device Catalogue Number: SPM-149
• Device Lot Number: A1C0052
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/14/2019
• Initial Report FDA Received Date: 09/11/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention