MAUDE Adverse Event Report: DAVOL INC., SUB. C.R. BARD, INC. KUGEL PATCH SURGICAL MESH

Model Number 0010101

Device Problems Defective Device (2588); Insufficient Information (3190)

Patient Problems Pain (1994); Hernia (2240); Disability (2371)

Event Date 08/16/2011

Event Type  Injury  

Manufacturer Narrative

Information provided was limited an no conclusions can be made. The information provided alleged that post implant of the kugel mesh, the patient underwent surgery "to have a recurrence repair. " it is unclear at this time if recurrence repaired post implant of the mesh was a recurrence of the original hernia defect or a new hernia defect, however, recurrence is a known inherent risk of hernia repair surgery and is identified in the adverse reaction section of the instructions-for-use as a possible complication. If additional event and/or evaluation information is obtained, a follow up mdr will be submitted. Note: section a through f - the information provided by bard 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 bard. Not returned to manufacturer.

Event Description

The following was reported to davol by the patient's attorney: (b)(6) 2008 - the patient underwent an abdominal surgery for an inguinal hernia, the patient's hernia was repaired with a bard/davol kugel patch. (b)(6) 2011 - the patient underwent surgery to have a recurrence repair. The attorney alleges the patient has suffered and will continue to suffer pain and was seriously and permanently injured.

• Brand Name: KUGEL PATCH
• Type of Device: SURGICAL MESH
• Manufacturer (Section D): DAVOL INC., SUB. C.R. BARD, INC.; 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: steven figueroa ; 100 crossings blvd.; warwick, RI 02886 ; 4018258460
• MDR Report Key: 7150637
• MDR Text Key: 95908775
• Report Number: 1213643-2017-01113
• Device Sequence Number: 1
• Product Code: FTL
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K963141
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: consumer,other
• Reporter Occupation: Attorney
• Type of Report: Initial
• Report Date: 12/28/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/28/2017
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No

Device Operator

• Device Expiration Date: 02/28/2013
• Device Model Number: 0010101
• Device Catalogue Number: 0010101
• Device Lot Number: HUSB0007
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No

Was the Report Sent to FDA?

• Event Location: No Information
• Date Manufacturer Received: 12/04/2017
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 02/20/2008
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial

Patient Treatment Data

Date Received: 12/28/2017 Patient Sequence Number: 1