MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,foreign,health pr report with the FDA on 2016-04-01 for MESO BIOMATRIX ACELLULAR PERITONEUM MATRIX 30055-05 manufactured by Dsm Biomedical.
[41669126]
Review of the device history records revealed no deviations that would contribute to the reported complications. The product met all pre-determined acceptance criteria. Review of sterilization records indicate the product was processed in accordance with product requirements and met all pre-determined acceptance criteria for sterility. The cause of the complication can not be determined from the provided information or the manufacturing records. Multiple attempts have been made to obtain additional clinical information. If additional information is provided, it will be reported in a follow-up report. Device not returned.
Patient Sequence No: 1, Text Type: N, H10
[41669127]
It was reported that the patient had meso biomatrix implanted as of a breast reconstruction surgical procedure. At an unknown time post-operative, seroma, breast erythema and pain were reported. The meso biomatrix was subsequently explanted. It was reported that the mesh had a 'jelly-like' in appearance at the time of explantation and was not incorporated with the subcutaneous tissue. No additional information is available as of the date of this initial report.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2530154-2016-00009 |
| MDR Report Key | 5541616 |
| Report Source | DISTRIBUTOR,FOREIGN,HEALTH PR |
| Date Received | 2016-04-01 |
| Date of Report | 2016-04-01 |
| Date Mfgr Received | 2016-03-04 |
| Device Manufacturer Date | 2015-02-04 |
| Date Added to Maude | 2016-04-01 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. FORDE HANSELL |
| Manufacturer Street | 735 PENNSYLVANIA DRIVE |
| Manufacturer City | EXTON PA 19341 |
| Manufacturer Country | US |
| Manufacturer Postal | 19341 |
| Manufacturer Phone | 4847132152 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MESO BIOMATRIX ACELLULAR PERITONEUM MATRIX |
| Generic Name | MESH, SURGICAL, COLLAGEN, PLASTIC AND RECONSTRUCTIVE SURGERY |
| Product Code | OXH |
| Date Received | 2016-04-01 |
| Model Number | 30055-05 |
| Lot Number | C5183 |
| Device Expiration Date | 2016-12-31 |
| Operator | PHYSICIAN |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DSM BIOMEDICAL |
| Manufacturer Address | 735 PENNSYLVANIA DRIVE EXTON PA 19341 US 19341 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2016-04-01 |