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

Catalog Number	0010302
Medical Device Problem Code	Patient-Device Incompatibility (2682)
Health Effect - Clinical Codes	Adhesion(s) (1695); Hernia (2240)
Date of Event	10/02/2017
Type of Reportable Event	Serious Injury
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-jul-2014) is considered to be a best estimate.This mdr represents the ventralex mesh (device 2).Additional supplemental emdr's were submitted to represent the bard flat mesh (device 1), perfix plug (device 2), ventralex mesh (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.
Event or Problem Description
Per information provided: (b)(6) 2011 - patient was diagnosed with umbilical hernia thereby underwent open repair with implant of bard flat mesh (device 1).Per op notes, ¿the hernia sac was noted and excised.A bard flat mesh (device 1) was placed and sutured.¿ (b)(6) 2011 - patient was diagnosed with recurrent right inguinal hernia thereby underwent open repair with implant of perfix plug (device 2).Per op notes, ¿the hernia sac was noted and reduced.A perfix plug was placed with onlay patch and sutured.¿ (b)(6) 2013 - patient was diagnosed with recurrent ventral hernia thereby underwent open repair with implant of ventralex mesh (device 3).(note: there is no operative notes provided for this procedure) (b)(6) 2014 - patient was diagnosed with recurrent ventral hernia thereby underwent open repair with implant of ventralex mesh (device 4).Per op notes, ¿the hernia sac was noted and dissected free.The contents of hernia sac were reduced.The prior meshes (device 1 and 3) were noted to rolled underneath to permit the new hernia.A ventralex mesh (device 4) was placed and sutured.¿ (b)(6) 2017 - patient was diagnosed with recurrent incisional hernia and right femoral hernia thereby underwent laparoscopic repair with excision of bard flat mesh (device 1), ventralex mesh (device 3 and 4) and implant of two synthetic meshes.Per op notes, ¿adhesions were noted and lysed.The incisional hernia sac was noted and reduced.The prior meshes (device 1,3 and 4) were noted and excised entirely.A synthetic mesh was placed and sutured.The femoral hernia sac on right groin was noted and reduced.A synthetic mesh was placed and sutured.¿.

• Brand Name: MESH - VENTRALEX
• 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: 23531426
• Report Number: 1213643-2025-01088
• Device Sequence Number: 9083441
• Product Code: FTL
• UDI-Device Identifier: 00801741016479
• UDI-Public: (01)00801741016479(17)180128(10)HUYG0721
• Combination Product (Y/N): N
• Initial Reporter State: NY
• Initial Reporter Country: US
• PMA/510(K) Number: K021736
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2014
• Device Explanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 11/07/2025

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: 01/28/2018
• Device Catalogue Number: 0010302
• Device Lot Number: HUYG0721
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/22/2025
• Initial Report FDA Received Date: 11/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 07/15/2014
• 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: 66 YR
• Patient Sex: Male