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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: DAVOL INC., SUB. C.R. BARD, INC. MESH COMPOSIX; SURGICAL MESH

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DAVOL INC., SUB. C.R. BARD, INC. MESH COMPOSIX; SURGICAL MESH Back to Search Results
Catalog Number UNKAA018
Device Problems Defective Device (2588); Patient Device Interaction Problem (4001)
Patient Problems Fistula (1862); Unspecified Infection (1930); Hernia (2240)
Event Date 06/25/2013
Event Type  Injury  
Manufacturer Narrative
No conclusions can be made.The patient's attorney alleges adverse patient outcome associated with the hernia mesh used to treat the patient including hernia recurrence, infection, fistula and subsequent surgical intervention for mesh removal.The instructions-for-use (ifu) supplied with the device lists fistula and hernia recurrence as possible complications.No lot number has been provided; therefore, a review of the manufacturing records is not possible.In regards to the infection, the warnings section of the ifu states "if an infection develops, treat the infection aggressively.The prosthesis may not have to be removed.An unresolved infection, however, may require removal of the prosthesis." should additional information be provided, a supplemental emdr will be submitted.
 
Event Description
Attorney alleges that the patient underwent an incisional hernia repair surgery on (b)(6) 2013 and a bard/davol composix mesh was implanted.It is alleged that further to the implantation of the product, the patient suffered the development of fatigue, polydipsia, chronic infection, chronic fistula, chronic pain, fluid accumulation in the abdominal wall, and hernia recurrence.The patient experienced severe pain and suffering, and necessitating a partial mesh removal and revision surgery on (b)(6) 2013.It is alleged that the patient has suffered injuries, losses and damages resulting from numerous defects in the product that create an unreasonably high risk of injury with severe permanent adverse health consequences.It is also alleged the patient was treated with a course of hospitalization, diagnostic imaging, revision surgery, serum testing, antibiotics, analgesics and rest.Attorney alleges that the patient will require further invasive repair surgery, physiotherapy, rehabilitation and will continue to require other forms of medical care.It is also alleged that the device was defective.
 
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Brand Name
MESH COMPOSIX
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
andrew topoulos
100 crossings blvd.
warwick, RI 02886
4018258495
MDR Report Key12322183
MDR Text Key266585702
Report Number1213643-2021-06866
Device Sequence Number1
Product Code FTL
Combination Product (y/n)N
Reporter Country CodeCA
PMA/PMN Number
K971745
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type consumer,other
Reporter Occupation Non-Healthcare Professional
Type of Report Initial
Report Date 08/14/2021
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
Device Operator Health Professional
Device Catalogue NumberUNKAA018
Was Device Available for Evaluation? No
Initial Date Manufacturer Received 07/22/2021
Initial Date FDA Received08/14/2021
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 Sequence Number1
Patient Outcome(s) Hospitalization; Required Intervention; Disability;
Patient Age47 YR
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