MAUDE Adverse Event Report: DAVOL INC., SUB. C.R. BARD, INC. SEPRAMESH IP SURGICAL MESH

Catalog Number UNKAA066

Device Problems Defective Device; Insufficient Information

Event Type  Injury  

Manufacturer Narrative

The complainant has indicated that no additional information would be provided at this time. Based on the information available, no conclusions can be made. A lot number was not provided, therefore a review of the manufacturing records could not be conducted. Recurrence is identified in the adverse reaction section of the ifu as a possible complication. If additional information is obtained, a supplemental mdr will be submitted. This mdr represents the sepramesh reported to have been implanted in 2011. A separate mdr was sent to document the bard mesh reported to have been implanted in 2009. 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. Device remains implanted.

Event Description

It has been reported that in 2009 the patient underwent abdominal hernia repair and was implanted with a bard mesh device. As reported the hernia recurred and in 2011 the patient twice underwent emergency surgery and was implanted with a bard sepramesh. Following the surgery in 2011 it is reported that the patient experienced complications of bleeding in which a drain had to be placed, numbness of the leg (unspecified side), hernia recurrence and most recently in 2016 a bowel obstruction and hospitalization.

• Brand Name: SEPRAMESH IP
• Type of Device: SURGICAL MESH
• Manufacturer (Section D): DAVOL INC., SUB. C.R. BARD, INC.; 100 crossings blvd.; warwick RI 02886
• Manufacturer (Section G): BARD SHANNON LIMITED -3005636544; san geronimo industrial park; lot #1, road #3, km 79.7; humacao PR 00791
• Manufacturer Contact: jan ling ; 100 crossings blvd.; warwick , RI 02886 ; 8015652663
• MDR Report Key: 6234259
• Report Number: 1213643-2017-00015
• Device Sequence Number: 1
• Product Code: FTL
• Report Source: Manufacturer
• Source Type: CONSUMER

Reporter Occupation

• Type of Report: Initial
• Report Date: 09/11/2018

1 Device Was Involved in the Event

1 Patient Was Involved in the Event

• Date FDA Received: 01/09/2017
• Is This An Adverse Event Report?: Yes
• Is This A Product Problem Report?: No
• Device Operator: Health Professional
• Device Catalogue Number: UNKAA066
• Was Device Available For Evaluation?: No

Is The Reporter A Health Professional?

Was the Report Sent to FDA?

• Event Location: No Information
• Date Manufacturer Received: 08/22/2016
• 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?: No
• Type of Device Usage: Initial

Patient TREATMENT DATA

Date Received: 01/09/2017 Patient Sequence Number: 1