MAUDE Adverse Event Report: DAVOL INC., SUB. C.R. BARD, INC. -1213643 PERFIX PLUG LIGHT; SURGICAL MESH

Catalog Number	0117050
Medical Device Problem Codes	Defective Device (2588); Insufficient Device Problem Information (3190); Patient Device Interaction Problem (4001)
Health Effect - Clinical Codes	Adhesion(s) (1695); Hernia (2240); Injury (2348)
Date of Event	03/03/2014
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
At this time no conclusions can be made regarding the bard/davol perfix light plug (device #2) used to treat the patient.The patient's attorney did allege surgical intervention; 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.This emdr represents the bard/davol perfix light plug (device #2).An additional emdr was submitted to represent the bard/davol bard flat mesh (device #1).Not returned.
Event or Problem Description
Attorney alleges that on (b)(6) 2012 or (b)(6) 2014, the patient underwent surgery for implant of an unspecified bard/davol bard mesh (device #1) or an unspecified bard/davol perfix light plug (device #2).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 mesh (device #1) and perfix light plug (device #2).As reported, the attorney alleges product is defective and that the patient experienced emotional distress.
Event or Problem Description
Attorney alleges that on (b)(6) 2012 or (b)(6) 2014, the patient underwent surgery for implant of an unspecified bard/davol bard mesh (device #1) or an unspecified bard/davol perfix light plug (device #2).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 mesh (device #1) and perfix light plug (device #2).As reported, the attorney alleges product is defective and that the patient experienced emotional distress.Addendum per additional information provided: (b)(6) 2012 ¿ patient was diagnosed with recurrent right inguinal hernia thereby underwent open repair with the implant of perfix light plug (device #1).Per op notes, ¿a perfix light plug (device #1) was placed in the internal ring and mesh was placed on canal floor and secured using sutures.¿ (b)(6) 2014 ¿ patient was diagnosed with indirect recurrent right inguinal hernia thereby underwent laparoscopic repair with implant of bard flat mesh (device #2).Per op notes, ¿small indirect hernia sac was identified.The tissue adherent to plug (device #1) was dissected out.A bard flat mesh (device #2) was placed into preperitoneal space and anchored to pubic ramus and pubic tubercle.¿.
Additional Manufacturer Narrative
At this time no conclusions can be made regarding the bard/davol perfix light plug (device #2) used to treat the patient.The patient's attorney did allege surgical intervention; 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-apr-2012) is considered to be a best estimate.This supplemental emdr represents the bard/davol perfix light plug (device #1).An additional supplemental emdr was submitted to represent the bard/davol bard flat mesh (device #2).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 LIGHT
• 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: 8642351
• Report Number: 1213643-2019-04352
• Device Sequence Number: 1680965
• Product Code: FTL
• UDI-Device Identifier: 00801741030949
• UDI-Public: (01)00801741030949(17)170528(10)HUWD1439
• Combination Product (Y/N): N
• Initial Reporter State: KS
• Initial Reporter Country: US
• PMA/510(K) Number: K092032
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2012
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 05/20/2025

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: 05/28/2017
• Device Catalogue Number: 0117050
• Device Lot Number: HUWD1439
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/08/2019
• Supplement Date Received by Manufacturer: 05/14/2025
• Initial Report FDA Received Date: 05/24/2019
• Supplement Report FDA Received Date: 05/20/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 04/15/2012
• 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: 38 YR
• Patient Sex: Male
• Patient Weight: 98 KG