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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ETHICON INC. MALLA PROLENE SMALL 6CM X 11CM MESH, SURGICAL, POLYMERIC

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ETHICON INC. MALLA PROLENE SMALL 6CM X 11CM MESH, SURGICAL, POLYMERIC Back to Search Results
Catalog Number PMS3
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Erythema (1840); Inflammation (1932)
Event Date 10/21/2018
Event Type  Injury  
Manufacturer Narrative
Product complaint # (b)(4). To date the device has not been returned. If the device or further details are received at a later date a supplemental medwatch will be sent. Attempts are being made to obtain the following information.   to date no response has been provided. If further details are received at a later date a supplemental medwatch will be sent. Patient symptoms manifestations (location, severity, appearance, systemic or local reaction) date - time of onset of infection from the surgical procedure? were there any pre-existing signs/symptoms of active infection prior to this surgical procedure? did the patient receive any prophylactic antibiotics pre-, intra- or post-operation? were cultures performed? results? what medical intervention was performed? results?.
 
Event Description
It was reported that a patient underwent a tension free inguinal hernia repair procedure on (b)(6) 2018 and the mesh was implanted. It was reported that the patient suffered from erythema and inflammation on the wound three days after sewing in the surgery. It was reported that the doctor treated the patient for anti-inflammation and anti-infection, and dressing was changed accordingly. The patient's condition changed better.
 
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Brand NameMALLA PROLENE SMALL 6CM X 11CM
Type of DeviceMESH, SURGICAL, POLYMERIC
Manufacturer (Section D)
ETHICON INC.
p.o. box 151, route 22 west
somerville NJ 08876
Manufacturer (Section G)
ETHICON INC.-SAN LORENZO PR
982 road 183 km 8.3
san lorenzo 00754
Manufacturer Contact
kara ditty-bovard
p.o. box 151, route 22 west
somerville, NJ 08876
6107428552
MDR Report Key9306787
MDR Text Key166816090
Report Number2210968-2019-89816
Device Sequence Number1
Product Code FTL
Combination Product (y/n)N
Reporter Country CodeCH
PMA/PMN Number
K962530
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Reporter Occupation
Type of Report Initial,Followup
Report Date 10/24/2019
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received11/11/2019
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator
Device Catalogue NumberPMS3
Device Lot NumberKWF554
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received12/18/2019
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device?
Type of Device Usage Initial

Patient Treatment Data
Date Received: 11/11/2019 Patient Sequence Number: 1
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