MAUDE Adverse Event Report: Davol Inc., Sub. C.R. Bard, Inc. -1213643 PerFix Plug; Surgical Mesh

Catalog Number	0112780
Medical Device Problem Code	Patient-Device Incompatibility (2682)
Health Effect - Clinical Codes	Adhesion(s) (1695); Hernia (2240)
Date of Event	11/05/2021
Type of Reportable Event	Serious Injury
Event or Problem Description
Per information provided: (b)(6) 2010 - patient was diagnosed with right inguinal hernia thereby underwent open repair with the implant of perfix plug (device 1).Per op notes, "an incision to the right groin, a large perfix plug (device 1) was placed to the inguinal floor using sutures." (b)(6) 2011 - patient was diagnosed with recurrent right inguinal hernia thereby underwent open repair with the implant of two perfix plugs (device 2 and 3).Per op notes, "an incision was carried down through the previous incision to the subcutaneous tissue.Identification of the femoral vessels, there was a defect laterally to the cord for which the extra large perfix plug (device 2) was placed.Upon palpation a femoral defect was palpated and a small perfix plug (device 3) was placed in the defect and sutured." (b)(6) 2021 - patient was diagnosed with recurrent right inguinal hernia thereby underwent repair with removal of all previous meshes (device 1, 2 and 3) and implant of 3dmax mid mesh (device 4).Per op notes, "the peritoneum was densely adherent to the previous mesh plug, which was actually intraabdominal.Able to dissect this off the plug and separate the peritoneum from the cord structures.The plugs (device 1, 2 and 3) was then excised.A right sided 3dmax mid mesh (device 4) was placed to the abdominal wall.".
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 perfix plug (device 1).An additional emdr was created to represent the perfix plug (device 3) in gcs.Note, the manufacturing date (15-nov-2010) 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 ; +1(800)556-6756
• MDR Report Key: 50895526
• Report Number: 1213643-2026-01235
• Device Sequence Number: 10684132
• Product Code: FTL
• UDI-Device Identifier: 00801741016622
• UDI-Public: (01)00801741016622(17)151228(10)HUUK1763
• Combination Product (Y/N): N
• Initial Reporter State: NY
• 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: 2021
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 09/21/2026

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: 12/28/2015
• Device Catalogue Number: 0112780
• Device Lot Number: HUUK1763
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/15/2026
• Initial Report FDA Received Date: 09/25/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 11/15/2010
• 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 Sex: Male
• Patient Weight: 165 LB