MAUDE Adverse Event Report: DAVOL INC., SUB. C.R. BARD, INC. -1213643 BARD MESH PRE-SHAPED W/ KEYHOLE; SURGICAL MESH

Catalog Number	0112710
Medical Device Problem Codes	Defective Device (2588); Patient-Device Incompatibility (2682); Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Nerve Damage (1979); Pain (1994); Hernia (2240); Injury (2348); Disability (2371)
Date of Event	05/20/2020
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
No conclusions can be made.The patient's attorney alleges "past, present, and future damages, including but not limited to, mental and physical pain and suffering for severe and permanent personal injuries sustained by the patient"; however, no details have been provided.No lot number has been provided; therefore, a review of the manufacturing records is not possible.Should additional information be provided, a supplemental emdr will be submitted.Not returned.
Event or Problem Description
Attorney alleges that the patient underwent surgery for implant of an unspecified bard mesh (bard flat mesh) on (b)(6) 2019.As reported, the patient is making a claim for an adverse patient outcome against the bard mesh (bard flat mesh).Attorney alleges general allegations for "past, present, and future damages, including but not limited to, mental and physical pain and suffering for severe and permanent personal injuries sustained by the patient." it is also alleged that the patient experienced emotional distress and the device was defective.
Additional Manufacturer Narrative
No conclusions can be made.The patient's attorney alleges "past, present, and future damages, including but not limited to, mental and physical pain and suffering for severe and permanent personal injuries sustained by the patient"; however, no details have been provided.No lot number has been provided; therefore, a review of the manufacturing records is not possible.Addendum: h11: this supplemental emdr is submitted to document additional information provided and to correct sex of patient, brand name, pma/510(k)#.Root cause is inconclusive; no conclusion can be made as to the extent to which the implant may have caused or contributed to the patient's postoperative course.Note, the manufacturing date (15-jul-2019) is considered to be a best estimate.This supplements emdr represents bard pre-shaped w/ keyhole (device #1).An mdr was submitted to represent the bard soft mesh pre-shaped with keyhole mesh (device #2).Note: section a through f - the information provided by bd 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 bd.
Event or Problem Description
Attorney alleges that the patient underwent surgery for implant of an unspecified bard mesh (bard flat mesh) on (b)(6) 2019.As reported, the patient is making a claim for an adverse patient outcome against the bard mesh (bard flat mesh).Attorney alleges general allegations for "past, present, and future damages, including but not limited to, mental and physical pain and suffering for severe and permanent personal injuries sustained by the patient." it is also alleged that the patient experienced emotional distress and the device was defective.Addendum per additional information provided: (b)(6) 2019 ¿ patient was diagnosed with indirect bilateral inguinal hernia, femoral hernia and umbilical hernia thereby underwent open repair with the implant of bard pre-shaped keyhole mesh (right - device #1) & bard soft mesh pre-shaped with keyhole (left - device #2).Per operative notes, ¿on right, a large indirect hernia defect was identified.Floor was reinforced using bard pre-shaped with keyhole mesh (device #1), which secured to symphysis pubis using suture.On left, a small indirect hernia and femoral hernia was noted.A bard soft mesh pre-shaped with keyhole (device #2) was secured to pubic tubercle using sutures.An umbilical hernia was repaired using sutures¿ (b)(6) 2020 ¿ patient was diagnosed with bilateral inguinal pain, recurrent direct right inguinal hernia, recurrent ventral hernia thereby underwent open repair with the implant of bard pre-shaped keyhole mesh (right - device #3) for right inguinal hernia and bard flat mesh (device #4) for ventral hernia.Per operative notes, ¿on right, a recurrent hernia was noted.The ilioinguinal nerve and genitofemoral nerve encased in scar was amputated.The iliohypogastric nerve was found proximity to previous mesh was divided.A large pre-shaped with keyhole mesh (device #3) was placed and tacked to pubic symphysis.The recurrent ventral hernia was repaired using a bard flat mesh (device #4), which tacked to overlying tissue to abdominal wall circumferentially.In left groin, scar was encountered.Left iliohypogastric nerve and genitofemoral nerve were resected.¿.

• Brand Name: BARD MESH PRE-SHAPED W/ KEYHOLE
• Common Device Name: SURGICAL MESH
• Manufacturer (Section D): DAVOL INC., SUB. C.R. BARD, INC. -1213643; 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: andrew topoulos ; 100 crossings blvd.; warwick, RI 02886 ; 4018258495
• MDR Report Key: 10874999
• Report Number: 1213643-2020-10440
• Device Sequence Number: 14535383
• Product Code: FTL
• UDI-Device Identifier: 00801741016554
• UDI-Public: (01)00801741016554(17)240728(10)HUDU1631
• Combination Product (Y/N): N
• Initial Reporter State: RI
• Initial Reporter Country: US
• PMA/510(K) Number: K052155
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Device Explanted Year: 2020
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/08/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Expiration Date: 07/28/2024
• Device Catalogue Number: 0112710
• Device Lot Number: HUDU1631
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/18/2020
• Supplement Date Received by Manufacturer: 07/17/2025
• Initial Report FDA Received Date: 11/20/2020
• Supplement Report FDA Received Date: 08/08/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 07/15/2019
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Disability; Required Intervention
• Patient Age: 50 YR
• Patient Sex: Male
• Patient Weight: 92 KG