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); Patient-Device Incompatibility (2682); Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Adhesion(s) (1695); Purulent Discharge (1812); Unspecified Infection (1930); Hernia (2240); Injury (2348)
Date of Event	02/12/2016
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Based on the information provided at this time, no conclusion can be made as to the degree to which the bard/davol device may have caused or contributed to the alleged patient outcome.The attorney alleges that the patient had subsequent surgical intervention; however, no details/medical records have been provided at this time.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.Not returned.
Event or Problem Description
It is alleged by the patient's attorney that the patient underwent surgery for implant of an unspecified bard/davol kugel hernia patch on (b)(6) 2009.It is alleged that the patient had subsequent surgical intervention due to the hernia mesh device.As reported, the patient is making a claim for an adverse patient outcome against the bard/davol kugel hernia patch.As reported, the attorney alleges patient experienced emotional distress and the device was defective.
Additional Manufacturer Narrative
Based on the information provided at this time, no conclusion can be made as to the degree to which the bard/davol device may have caused or contributed to the alleged patient outcome.The attorney alleges that the patient had subsequent surgical intervention; however, no details/medical records have been provided at this time.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-nov-2008) 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.
Event or Problem Description
It is alleged by the patient's attorney that the patient underwent surgery for implant of an unspecified bard/davol kugel hernia patch on (b)(6) 2009.It is alleged that the patient had subsequent surgical intervention due to the hernia mesh device.As reported, the patient is making a claim for an adverse patient outcome against the bard/davol kugel hernia patch.As reported, the attorney alleges patient experienced emotional distress and the device was defective.Addendum per additional information provided: (b)(6) 2009 - patient was diagnosed with large ventral hernia thereby underwent open repair with implant of kugel hernia patch.Per operative notes, ¿a large hernia sac was identified and excised.A kugel hernia patch was placed using prolene sutures.¿ (b)(6) 2016 - patient was diagnosed with infected mesh with chronic sinus tract and recurrent ventral hernia thereby underwent open repair with excision of kugel hernia patch.Per operative notes, ¿adhesiolysis was performed to free up abdominal wall.The infected mesh with chronic sinus tract and purulence was excised.The small bowel adherent to mesh was resected.The prior mesh was excised completely.The hernia defect was identified and repaired with primary fascial sutures.¿.

• 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: 8529338
• Report Number: 1213643-2019-03197
• Device Sequence Number: 1899869
• Product Code: FTL
• UDI-Device Identifier: 00801741016349
• UDI-Public: (01)00801741016349(10)HUSK1324
• Combination Product (Y/N): N
• Initial Reporter State: CO
• Initial Reporter Country: US
• PMA/510(K) Number: K963141
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2009
• Device Explanted Year: 2016
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/05/2025

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 Catalogue Number: 0010102
• Device Lot Number: HUSK1324
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/29/2019
• Supplement Date Received by Manufacturer: 05/28/2025
• Initial Report FDA Received Date: 04/18/2019
• Supplement Report FDA Received Date: 06/05/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/15/2008
• 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: Female