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

Catalog Number	0112780
Medical Device Problem Codes	Defective Device (2588); Patient Device Interaction Problem (4001)
Health Effect - Clinical Code	Hernia (2240)
Date of Event	05/18/2012
Type of Reportable Event	Serious Injury
Event or Problem Description
Per additional information provided: on (b)(6) 2009, patient was diagnosed with large left inguinal hernia, lipoma of the cord thereby underwent open repair with the implant of three perfix plug mesh (device #1, device #2, device #3).Per operative notes, ¿three perfix plug mesh and patch was placed and sutured.¿ on (b)(6) 2012, patient was diagnosed with massive recurrent left inguinal hernia thereby underwent open repair with the explant of perfix plug mesh and implant of proloop mesh.Per operative notes, ¿previously placed mesh was dissected.A proloop mesh was placed and sutured.¿ on (b)(6) 2012, patient was diagnosed with left scrotal exploration, scrotal hematoma thereby underwent open repair.On (b)(6) 2013, patient was diagnosed with right inguinal hernia thereby underwent open repair with the implant of two perfix plug mesh (device #4, device #5).Per operative notes, ¿two extra large perfix plug mesh (device #4, device #5) was placed and sutured.¿.
Additional Manufacturer Narrative
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-jun-2009) is considered to be a best estimate.This emdr represents the bard/davol perfix plug mesh (device #2).Supplemental emdrs and emdrs were submitted to represent two bard/davol mesh - perfix plug mesh (device #1) and (device #3).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.

• Brand Name: PERFIX PLUG
• 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: 22001479
• Report Number: 1213643-2025-090204
• Device Sequence Number: 7267329
• Product Code: FTL
• UDI-Device Identifier: 00801741016622
• UDI-Public: (01)00801741016622(17)140728(10)HUTF2279
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: K922916
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2009
• Device Explanted Year: 2012
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 05/12/2025

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: 07/28/2014
• Device Catalogue Number: 0112780
• Device Lot Number: HUTF2279
• Was Device Available for Evaluation?: No
• Event Location: Hospital
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 05/05/2025
• Initial Report FDA Received Date: 05/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 06/15/2009
• 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: Required Intervention
• Patient Age: 43 YR
• Patient Sex: Male