MAUDE Adverse Event Report: SOFRADIM PRODUCTION SAS PROGRIP; MESH, SURGICAL, POLYMERIC

Model Number LPG1510X2

Device Problems Material Integrity Problem (2978); Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Adhesion(s) (1695); Hematoma (1884); Pain (1994); Tachycardia (2095); Injury (2348); Blood Loss (2597); Abdominal Distention (2601); No Code Available (3191)

Event Type  Injury  

Manufacturer Narrative

(b)(4).If information is provided in the future, a supplemental report will be issued.

Event Description

The patient¿s attorney alleged a deficiency against the device.The product was used for therapeutic treatment of an incisional hernia.It was reported that after underlay implant, the patient experienced mesh contraction, hematoma, abdominal wall mass, pain, adhesions, murky looking tissue, bulging, significant bleeding and was tachycardic.Post-operative patient treatment included blood transfusion, revision surgery.The device had been used with 31626 c-qur tacshield, lot# 410314005, exp date 2019-11-29.

• Brand Name: PROGRIP
• Type of Device: MESH, SURGICAL, POLYMERIC
• Manufacturer (Section D): SOFRADIM PRODUCTION SAS; 116 avenue du formans; trevoux 01600 ; FR 01600
• Manufacturer (Section G): SOFRADIM PRODUCTION SAS; 116 avenue du formans; trevoux 01600 ; FR 01600
• Manufacturer Contact: lisa hernandez ; 60 middletown ave.; north haven, CT 06473 ; 2034925563
• MDR Report Key: 9680387
• MDR Text Key: 178112159
• Report Number: 9615742-2020-00360
• Device Sequence Number: 1
• Product Code: FTL
• UDI-Device Identifier: 10884521513266
• UDI-Public: 10884521513266
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K142900
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: consumer
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date: 02/07/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/07/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 12/31/2019
• Device Model Number: LPG1510X2
• Device Catalogue Number: LPG1510X2
• Device Lot Number: PRA2443X
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 01/29/2020
• Date Device Manufactured: 01/26/2017
• 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
• Treatment: 31626 C-QUR TACSHIELD(LOT# 410314005)
• Patient Outcome(s): Required Intervention
• Patient Age: 55 YR