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

Catalog Number	0112660
Medical Device Problem Code	Patient-Device Incompatibility (2682)
Health Effect - Clinical Codes	Adhesion(s) (1695); Hernia (2240)
Date of Event	02/12/2018
Type of Reportable Event	Serious Injury
Event or Problem Description
Per information provided: on (b)(6) 2006 - patient was diagnosed with recurrent incarcerated incisional hernia thereby underwent open repair with implant of bard flat mesh (device # 1).Per op notes, "a bard flat mesh (device # 1) was placed and sutured." on (b)(6) 2007 - patient was diagnosed with recurrent incisional hernia thereby underwent open repair with implant of ventralex mesh (device #2).Per op notes, "a ventralex mesh (device # 2) was placed and sutured." on (b)(6) 2009 - patient was diagnosed with recurrent incisional hernia thereby underwent open repair.On (b)(6) 2018 - patient was diagnosed with recurrent incisional hernia thereby underwent open repair with explant of bard flat mesh (device # 1) and ventralex mesh (device #2) and implant of sepramesh ip (device # 3).Per op notes, "adhesions were taken down.The meshes (device # 1 & # 2) were removed and a sepramesh ip (device # 3) was placed and sutured." on (b)(6) 2018 - patient was diagnosed with recurrent incarcerated incisional hernia thereby underwent laparoscopic repair with implant of ventralight st using echo ps (device # 4).Per op notes, "a ventralight st using echo ps (device # 4) was placed and tacked.".
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.This emdr was submitted to represent the bard flat mesh (device # 1).An additional supplemental emdr 's were submitted to represent the mesh ¿ ventralex (device # 2) and sepramesh ip (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: BARD FLAT MESH
• 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: 22343716
• Report Number: 1213643-2025-00529
• Device Sequence Number: 4901504
• Product Code: FTL
• UDI-Device Identifier: 00801741016516
• UDI-Public: (01)00801741016516(10)43JPD226
• Combination Product (Y/N): N
• Initial Reporter State: GA
• Initial Reporter Country: US
• PMA/510(K) Number: PREAMENDMENT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2006
• Device Explanted Year: 2018
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 06/18/2025

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 Catalogue Number: 0112660
• Device Lot Number: 43JPD226
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/10/2025
• Initial Report FDA Received Date: 06/27/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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: 54 YR
• Patient Sex: Male