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

Catalog Number	5950070
Medical Device Problem Codes	Defective Device (2588); Patient-Device Incompatibility (2682); Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Adhesion(s) (1695); Pain (1994); Hernia (2240); Injury (2348); Disability (2371)
Date of Event	02/13/2014
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
At this time no conclusions can be made regarding the bard/davol ventrio st (device #1) used to treat the patient.The patient's attorney alleges injuries; however, no details have been provided.No lot number has been provided therefore a review of the manufacturing records is not possible.This emdr represents the bard/davol ventrio st (device #1).The patient's attorney did not make any allegations regarding the implanted bard/davol bard flat mesh device.Should additional information be provided a supplemental emdr will be submitted.Not returned.
Event or Problem Description
Attorney alleges that on (b)(6) 2013, the patient underwent surgery for implant of an unspecified bard/davol ventrio st (device #1) and an unspecified bard/davol bard mesh.It is alleged that on (b)(6) 2017, the patient had unspecified injuries.As reported, the patient is only making a claim for an adverse patient outcome against the ventrio st (device #1).As reported, the patient 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.".
Additional Manufacturer Narrative
At this time no conclusions can be made regarding the bard/davol ventrio st (device #1) used to treat the patient.The patient's attorney alleges injuries; however, no details have been provided.No lot number has been provided therefore a review of the manufacturing records is not possible.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-dec-2011) is considered to be a best estimate.Updated fields: a2, b2, b3, b4, b5, d4 (product catalog no, corporate lot no, expiry date, udi), d6b (date of explant), 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.
Event or Problem Description
Attorney alleges that on (b)(6) 2013, the patient underwent surgery for implant of an unspecified bard/davol ventrio st (device #1) and an unspecified bard/davol bard mesh.It is alleged that on (b)(6) 2017, the patient had unspecified injuries.As reported, the patient is only making a claim for an adverse patient outcome against the ventrio st (device #1).As reported, the patient 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 additional information provided: (b)(6) 2013 - patient was diagnosed with incisional ventral hernias, pfannenstiel hernia (x2) thereby underwent open repair with implant of ventrio st mesh (device 1) for incisional hernias and ventrio st mesh (device 2) and bard flat mesh (device 3) for pfannenstiel hernia (x2).Per op notes, "for midline incisional hernia defects, a ventrio st mesh (device 1) was placed and sutured.For pfannenstiel hernia defects, a ventrio st mesh (device 2) and bard flat mesh (device 3) was placed and sutured." (b)(6) 2014 - patient was diagnosed with recurrent incisional ventral hernia thereby underwent open repair with removal of mesh (device 1) and implant of phasix mesh (device 4) and biological mesh.Per op notes, "the previous mesh (device 1) adherent to the fascia was dissected and completely removed.A phasix mesh (device 4) and biological mesh was placed and sutured.".

• Brand Name: VENTRIO ST
• 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: 8642335
• Report Number: 1213643-2019-04345
• Device Sequence Number: 2298815
• Product Code: FTL
• UDI-Device Identifier: 00801741031564
• UDI-Public: (01)00801741031564(17)131228(10)HUVL0371
• Combination Product (Y/N): N
• Initial Reporter State: RI
• Initial Reporter Country: US
• PMA/510(K) Number: K101920
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2013
• Device Explanted Year: 2014
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 09/12/2025

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: 12/28/2013
• Device Catalogue Number: 5950070
• Device Lot Number: HUVL0371
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/01/2019
• Supplement Date Received by Manufacturer: 08/27/2025
• Initial Report FDA Received Date: 05/24/2019
• Supplement Report FDA Received Date: 09/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 12/15/2011
• 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: 46 YR
• Patient Sex: Female