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

Catalog Number	0112750
Medical Device Problem Code	Patient-Device Incompatibility (2682)
Health Effect - Clinical Codes	Adhesion(s) (1695); Pain (1994); Hernia (2240)
Date of Event	06/08/2020
Type of Reportable Event	Serious Injury
Event or Problem Description
Per information provided: on (b)(6) 2019 - patient was diagnosed with three abdominal wall incisional hernia thereby underwent laparoscopic repair with implant of ventralight st mesh (device 1) and perfix plug (device 2) and one synthetic mesh.Per operative notes, ¿an incision was made into the peritoneal cavity.The hernia sac was dissected out.A ventralight st mesh (device 1) was placed into the peritoneal cavity and sutures.A perfix plug (device 2) and one synthetic mesh was placed together with previously placed (device 1) into the peritoneal cavity and sutures.¿ on (b)(6) 2020 ¿ patient was diagnosed with recurrent incisional hernia, pain, adhesion thereby underwent open repair with explant of ventralex st mesh (device 1) and perfix plug (device 2) and synthetic mesh and implant of ventrio st mesh (device 3).Per operative notes, ¿a midline incision was made through the prior midline surgical scars from the upper epigastric area.The hernia sac was dissected out.There were dense adhesions into the abdomen.All adhesions were taken down.Previously placed ventralex st mesh (device 1) and perfix plug (device 2) and synthetic mesh was dissected out from peritoneal space.A 7.7 x 9.7 cm ventrio st mesh (device 3) was placed into the defect and secure it with sutures.¿.
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 mdr represents the perfix plug (device 2).An additional supplemental emdr was submitted to represent the ventralight st mesh (device 1).Note, the manufacturing date (15-jan-2018) is considered to be a best estimate.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 ; 8005566756
• MDR Report Key: 24800642
• Report Number: 1213643-2026-00445
• Device Sequence Number: 18818160
• Product Code: FTL
• UDI-Device Identifier: 00801741016592
• UDI-Public: (01)00801741016592(17)221228(10)HUCN0247
• 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: 2019
• Device Explanted Year: 2020
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 04/01/2026

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: 12/28/2022
• Device Catalogue Number: 0112750
• Device Lot Number: HUCN0247
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/19/2026
• Initial Report FDA Received Date: 04/07/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 01/15/2018
• 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: 60 YR
• Patient Sex: Female