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

Catalog Number	0112760
Medical Device Problem Code	Material Deformation (2976)
Health Effect - Clinical Codes	Scar Tissue (2060); Hernia (2240)
Date of Event	12/02/2013
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-feb-2011) is considered to be a best estimate.This mdr represents the perfix plug (device 1).An additional supplemental emdr was submitted to represent the ventrio st mesh (device 2).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 recurrent right inguinal hernia, primary left inguinal hernia, thereby underwent open repair with implant of perfix plug (device 1), ventrio st mesh (device 2).Per op notes, ¿there was a direct weakness lateral to the external ring in right inguinal region.A perfix plug (device 1) was placed and sutured.On the left inguinal region, large ventral hernia sac was found.A ventrio st mesh (device 2) was placed and sutured¿.(b)(6) 2013- patient was diagnosed with recurrent incisional hernia, thereby underwent open repair with explant of perfix plug (device 1), ventrio st mesh (device 2) and implant of 3dmax meshes (device 3 and 4).Per op notes, ¿incision through the previous scar, hernia sac was identified and it contained a waded up piece of mesh which was removed (perfix plug- device 1, ventrio st mesh- device 2).Bilateral placement of 3dmax meshes (device 3 and 4) in the extraperitoneal space and there was a significant overlap in the middle.These mesh were trimmed and sutured¿.

• 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 ; 8005566756
• MDR Report Key: 24444434
• Report Number: 1213643-2026-00213
• Device Sequence Number: 13355364
• Product Code: FTL
• UDI-Device Identifier: 00801741016608
• UDI-Public: (01)00801741016608(17)160228(10)HUVB1147
• Combination Product (Y/N): N
• Initial Reporter State: RI
• Initial Reporter Country: US
• PMA/510(K) Number: K922916
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2011
• Device Explanted Year: 2013
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 02/14/2026

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: 02/28/2016
• Device Catalogue Number: 0112760
• Device Lot Number: HUVB1147
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/02/2026
• Initial Report FDA Received Date: 02/25/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 02/15/2011
• 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: 63 YR
• Patient Sex: Male