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

Catalog Number	0010102
Medical Device Problem Codes	Defective Device (2588); Material Deformation (2976); Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Adhesion(s) (1695); Pain (1994); Hernia (2240); Injury (2348); Disability (2371); Obstruction/Occlusion (2422)
Date of Event	03/01/2016
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
At this time no conclusions can be made.The patient's attorney alleges injuries and revision surgery; however, no details have been provided.No lot number has been provided; therefore a review of the manufacturing records is not possible.Should additional information be provided a supplemental emdr will be submitted.Device not returned.
Event or Problem Description
The following was alleged by the patient's attorney: on (b)(6) 2013: the patient underwent surgery for implant of an unspecified bard/davol kugel patch.On (b)(6) 2016: the patient had unspecified injuries related to a defect in the kugel patch and underwent revision surgery.The patient is making a claim for an adverse patient outcome against the kugel patch.The patient's attorney alleges general allegations for "past, present, and future damages, including but not limited to, mental and physical pain and suffering for severe and permanent personal injuries sustained by the patient.".
Event or Problem Description
The following was alleged by the patient's attorney: on (b)(6) 2013: the patient underwent surgery for implant of an unspecified bard/davol kugel patch.On (b)(6) 2016: the patient had unspecified injuries related to a defect in the kugel patch and underwent revision surgery.The patient is making a claim for an adverse patient outcome against the kugel patch.The patient's attorney alleges general allegations for "past, present, and future damages, including but not limited to, mental and physical pain and suffering for severe and permanent personal injuries sustained by the patient." addendum per medical records and plaintiff profile form: on (b)(6) 2013 ¿ patient was diagnosed with multiple small incisional hernia thereby underwent open repair with the implant of kugel patch (device #1).Per op notes, ¿a large oval kugel mesh was placed over the omentum and sutured to the underside of the fascia.¿ on (b)(6) 2016 ¿ patient was diagnosed with partial small bowel obstruction thereby underwent open small bowel resection.Per op notes, ¿the mesh (device #1) was opened and dissected off the surrounding tissue.The entire underside of the mesh and the abdominal wall was freed up from the adhesion.The small bowel distally had a significant amount of adhesions causing partial kinking with proximal dilated bowel were resected.The mesh and fascia were closed using sutures.¿ on (b)(6) 2020 ¿ patient was diagnosed with recurrent incisional hernia thereby underwent open repair with the implant of ventrio st (device #2).Per op notes, ¿the previous mesh (device #1) had a tear in the center allowed for the herniation.A small ventrio st (device #2) was put in the defect and sutured.¿.
Additional Manufacturer Narrative
At this time no conclusions can be made.The patient's attorney alleges injuries and revision surgery; however, no details have been provided.No lot number has been provided; therefore a review of the manufacturing records is not possible.Should additional information be provided a supplemental emdr will be submitted.Addendum: this supplemental emdr is submitted to document additional information provided.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-2010) is considered to be a best estimate.Updated fields: a2, b4, b5, b7, d3, d4 (product catalog no, corporate lot no, expiry date, udi no), g1, g3, g6, h2, h4, h6, h10.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.H3 other text : not returned.

• Brand Name: KUGEL PATCH
• 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 ; 4018258495
• MDR Report Key: 8367943
• Report Number: 1213643-2019-01061
• Device Sequence Number: 1587800
• Product Code: FTL
• UDI-Device Identifier: 00801741016349
• UDI-Public: (01)00801741016349(17)150728(10)HUUG0005
• Combination Product (Y/N): N
• Initial Reporter State: RI
• Initial Reporter Country: US
• PMA/510(K) Number: K963141
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2013
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 07/03/2025

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: 07/28/2015
• Device Catalogue Number: 0010102
• Device Lot Number: HUUG0005
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/04/2019
• Supplement Date Received by Manufacturer: 06/13/2025
• Initial Report FDA Received Date: 02/25/2019
• Supplement Report FDA Received Date: 07/03/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 07/15/2010
• 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: Disability; Required Intervention
• Patient Age: 47 YR
• Patient Sex: Female