FDA Adverse Event Injury Summary report: N

STRATTICE RECONSTRUCTIVE TISSUE MATRIX, 25 X 40, FIRM

MDR report key: 15707399 · Received November 1, 2022

Report

Report Number
1000306051-2022-00185
Event Type
Injury
Date Received
November 1, 2022
Date of Event
June 3, 2013
Report Date
March 15, 2023
Manufacturer
LIFECELL
Product Code
FTM
UDI-DI
00818410010416
PMA / PMN Number
K070560
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
PA, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

THIS LEGAL EVENT IS BEING REPORTED AS SERIOUS INJURY DUE TO THE REPORTED RECURRENCE WITH SURGICAL INTERVENTION. THE LOT ASSOCIATED WITH THIS EVENT WAS NOT REPORTED AND REMAINS UNKNOWN; THEREFORE AN INTERNAL INVESTIGATION INTO THE DEVICE HISTORY RECORDS COULD NOT BE PERFORMED. NO STRATTICE DEVICES WERE RETURNED FOR EVALUATION. BASED ON THE LIMITED INFORMATION, INCLUDING NO IDENTIFICATION OF THE LOT NUMBER, AND WITHOUT RELEVANT PATIENT FACTORS, A RELATIONSHIP BETWEEN THE EVENT AND THE STRATTICE COULD NOT BE DETERMINED. DUE TO THE LEGAL PROCESS, IF ADDITIONAL INFORMATION IS MADE AVAILABLE DURING LEGAL PROCEEDINGS, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Additional Manufacturer Narrative · 0

THE INTERNAL INVESTIGATION IS PENDING AND WILL BE REPORTED IN A FOLLOW UP REPORT ALONG WITH THE INVESTIGATION CONCLUSION. AS REPORTED IN THE INITIAL: THIS LEGAL EVENT IS BEING REPORTED AS SERIOUS INJURY DUE TO THE REPORTED RECURRENCE WITH SURGICAL INTERVENTION. THE LOT ASSOCIATED WITH THIS EVENT WAS NOT REPORTED AND REMAINS UNKNOWN; THEREFORE AN INTERNAL INVESTIGATION INTO THE DEVICE HISTORY RECORDS COULD NOT BE PERFORMED. NO STRATTICE DEVICES WERE RETURNED FOR EVALUATION. BASED ON THE LIMITED INFORMATION, INCLUDING NO IDENTIFICATION OF THE LOT NUMBER, AND WITHOUT RELEVANT PATIENT FACTORS, A RELATIONSHIP BETWEEN THE EVENT AND THE STRATTICE COULD NOT BE DETERMINED. DUE TO THE LEGAL PROCESS, IF ADDITIONAL INFORMATION IS MADE AVAILABLE DURING LEGAL PROCEEDINGS, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Description of Event or Problem · 0

IT WAS REPORTED THROUGH A LEGAL EVENT THAT A 55 YEAR OLD FEMALE PATIENT HAD HERNIA REPAIR SURGERY ON OR ABOUT (B)(6) 2012. DURING THE INCISIONAL HERNIA REPAIR SURGERY, THE SURGEON, DR. THOMAS TOMASIK, AT NORTHWESTERN MEDICINE, IMPLANTED A STRATTICE MESH, CATALOG NO. 2540002. AFTER SURGERY, THE PATIENT RETURNED TO NORTHWESTERN MEDICINE ON OR ABOUT (B)(6) 2013 AND WAS DIAGNOSED WITH A LARGE ABDOMINAL RECURRENT INCISIONAL HERNIA AND WAS REPORTING PAIN. ON OR ABOUT (B)(6) 2013, PATIENT UNDERWENT A RECURRENT INCISIONAL HERNIA REPAIR AND LYSIS OF ADHESIONS WITH THE PLACEMENT OF ADDITIONAL STRATTICE MESH, CATALOG NO. 2030002.

Description of Event or Problem · 0

THIS IS FOLLOW UP#1 TO REPORT ON 17/FEB/2023, PMQA RECEIVED NOTIFICATION FROM LEGAL THAT THE LOT ASSOCIATED WITH THIS EVENT WAS FOUND THROUGH DISCOVERY AND IS S11149-023. NO OTHER INFORMATION WAS REPORTED. AS REPORTED IN THE INITIAL: IT WAS REPORTED THROUGH A LEGAL EVENT THAT A 55 YEAR OLD FEMALE PATIENT HAD HERNIA REPAIR SURGERY ON OR ABOUT (B)(6) 2012. DURING THE INCISIONAL HERNIA REPAIR SURGERY, THE SURGEON, DR. THOMAS TOMASIK, AT NORTHWESTERN MEDICINE, IMPLANTED A STRATTICE MESH, CATALOG NO. 2540002. AFTER SURGERY, THE PATIENT RETURNED TO NORTHWESTERN MEDICINE ON OR ABOUT (B)(6) 2013 AND WAS DIAGNOSED WITH A LARGE ABDOMINAL RECURRENT INCISIONAL HERNIA AND WAS REPORTING PAIN. ON OR ABOUT (B)(6) 2013, PATIENT UNDERWENT A RECURRENT INCISIONAL HERNIA REPAIR AND LYSIS OF ADHESIONS WITH THE PLACEMENT OF ADDITIONAL STRATTICE MESH, CATALOG NO. 2030002.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
459892 STRATTICE RECONSTRUCTIVE TISSUE MATRIX, 25 X 40, FIRM MESH, SURGICAL FTM LIFECELL S11149 00818410010416

Patients

Seq Age Sex Outcome Treatment
1 55 YR Female Required Intervention NO INFORMATION.