MAUDE MDR 6322584

MDR report key
6322584
Report number
1213643-2017-00096
Event key
0
Event type
3
Date received
2017-02-10
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
LAURA BERG
Address
100 CROSSINGS BLVD. WARWICK RI 02886 US
Phone
401-401-4018
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1XENMATRIX ABPORCINE SURGICAL MESHPIJNAUNKAA105NIR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-02-1001. R

Event Narratives#

N

Patient 1

AS REQUESTED THE SURGEON WAS PROVIDED WITH A DOCTOR TO DOCTOR CONSULT. BASED ON INFORMATION OBTAINED FOLLOWING THE CONSULT IT APPEARS THAT THE PATIENT WAS EXPERIENCING AN EXAGGERATED FOREIGN BODY RESPONSE, IT ALSO APPEARS THAT THE GRAFT WAS NOT PLACED FLAT WHICH COULD CONTRIBUTE TO THE REPORTED INCORPORATION OF THE GRAFT. THE PRECAUTION SECTION OF THE IFU STATES, PLACE DEVICE IN MAXIMUM POSSIBLE CONTACT WITH HEALTH, WELL VASCULARIZED TISSUE TO PROMOTE CELL INGROWTH AND TISSUE REMODELING. INFLAMMATION AND ALLERGIC REACTION OR HYPERSENSITIVITY TO DEVICE MATERIALS ARE LISTED IN THE ADVERSE REACTION SECTION OF THE IFU AS POSSIBLE COMPLICATIONS. MULTIPLE ATTEMPTS HAVE BEEN MADE TO OBTAIN THE PRODUCT CODE AND LOT NUMBER OF THE XENMATRIX AB GRAFT, HOWEVER THE USER WAS NOT WILLING TO PROVIDE THIS INFORMATION. WITHOUT A LOT NUMBER A REVIEW OF THE MANUFACTURING RECORDS IS NOT POSSIBLE. BASED ON THE INFORMATION PROVIDED, NO DEFINITIVE CONCLUSION CAN BE MADE AS TO WHY THE GRAFT DID NOT INCORPORATE. SHOULD ADDITIONAL DETAILS BE PROVIDED, A SUPPLEMENTAL MDR WILL BE SUBMITTED. THE INFORMATION PROVIDED BY BARD REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO BARD. REMAINS IMPLANTED.

D

Patient 1

IT WAS REPORTED THAT ON (B)(6) 2016 THE PATIENT UNDERWENT A BREAST RECONSTRUCTION PROCEDURE IN WHICH THE SURGEON USED THE XENMATRIX AB IN THE ABDOMEN AS AN OVERLAY GRAFT ON THE RECTUS SHEATH TO REINFORCE A TRAM/DIEP. THE SURGEON NOW REPORTS THE GRAFT HAS INCREASED IN THICKNESS SINCE IMPLANT AND HAS NOT INCORPORATED. SURGEON ALSO REPORTS INFLAMMATION AND THE PATIENT IS COMPLAINING OF SEVERE PAIN. A PORTION OF THE GRAFT WAS SENT FOR CULTURE WITH RESULTS SHOWING NO INFECTION. THE SURGEON CONTACTED DAVOL AND REQUESTED A SURGEON CONSULT REGARDING THIS CASE.