MAUDE Adverse Event Report: DAVOL INC., SUB. C.R. BARD, INC. -1213643 VENTRALEX ST; SURGICAL MESH

Catalog Number	5950007
Medical Device Problem Code	Device Contamination with Chemical or Other Material (2944)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/07/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
As reported, a hair was found inside the folds of the white wrap (over the mesh).The subject device was returned for evaluation; however, at this time evaluation is not yet completed.When sample evaluation is completed, a supplemental emdr will be submitted.Review of manufacturing records shows product was made to specification.To date, this is the only reported complaint for this manufacturing lot of (b)(4) units released for distribution in december 2022.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
As reported, during a ventral hernia repair on (b)(6) 2024, while opening the sterile packaging, surgical technologist noted that inside the folds of the white wrap (over the mesh) had a small hair.It was reported that the mesh was not implanted, and another mesh was used to complete the procedure.There was no reported patient injury.
Additional Manufacturer Narrative
As reported, a hair was found inside the folds of the white wrap (over the mesh).The subject device was returned for evaluation; however, at this time evaluation is not yet completed.When sample evaluation is completed, a supplemental emdr will be submitted.Review of manufacturing records shows product was made to specification.To date, this is the only reported complaint for this manufacturing lot of (b)(4) units released for distribution in december 2022.Addendum: h11: this supplemental mdr is submitted to document the sample evaluation results.Sample evaluation confirmed a foreign matter (human hair) found on top of the inner sterile envelope next to the mesh strap.Based on sample and manufacturing process evaluation performed, the root cause is confirmed as manufacturing related.Awareness notification was provided to all appropriate personnel.Our records continue to show there have been no other reported complaints to date for this lot of (b)(4) units released for distribution in december 2022.Updated fields.Corrected field.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
As reported, during a ventral hernia repair on (b)(6) 2024, while opening the sterile packaging, surgical technologist noted that inside the folds of the white wrap (over the mesh) had a small hair.It was reported that the mesh was not implanted, and another mesh was used to complete the procedure.There was no reported patient injury.

• Brand Name: VENTRALEX ST
• 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 ; 8005566756
• MDR Report Key: 19527304
• Report Number: 1213643-2024-00305
• Device Sequence Number: 15347220
• Product Code: FTL
• UDI-Device Identifier: 00801741031472
• UDI-Public: (01)00801741031472
• Combination Product (Y/N): N
• Initial Reporter State: TN
• Initial Reporter Country: US
• PMA/510(K) Number: K101928
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,User Facility,Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/14/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 10/28/2024
• Device Catalogue Number: 5950007
• Device Lot Number: HUGY0953
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/10/2024
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/23/2024
• Supplement Date Received by Manufacturer: 07/01/2024
• Initial Report FDA Received Date: 06/13/2024
• Supplement Report FDA Received Date: 07/03/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 12/19/2022
• 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: Other
• Patient Sex: Unknown