MAUDE Adverse Event Report: Davol Inc., Sub. C.R. Bard, Inc. -1213643 Mesh - Composix L/P; Surgical Mesh

Catalog Number	0134810
Medical Device Problem Codes	Defective Device (2588); Patient-Device Incompatibility (2682); Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Abdominal Pain (1685); Adhesion(s) (1695); Scar Tissue (2060); Hernia (2240); Injury (2348)
Date of Event	11/10/2010
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
At this time no conclusions can be made.The patient's attorney alleges 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.Not returned.
Event or Problem Description
Attorney alleges that the patient underwent surgery for implant of an unspecified bard/davol composix l/p on (b)(6) 2009.As reported, the patient is making a claim for an adverse patient outcome against the bard/davol composix l/p.It is alleged that the patient had subsequent surgical intervention due to the hernia mesh device.As reported, the attorney alleges patient experienced emotional distress and the device was defective.
Event or Problem Description
Attorney alleges that the patient underwent surgery for implant of an unspecified bard/davol composix l/p on (b)(6) 2009.As reported, the patient is making a claim for an adverse patient outcome against the bard/davol composix l/p.It is alleged that the patient had subsequent surgical intervention due to the hernia mesh device.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 two ventral hernias thereby underwent laparoscopic repair with implant of composix l/p mesh (device 1 and 2).Per op notes, ¿lysis of adhesions was performed.First hernia sac was identified in the right lower quadrant and the contents were reduced.A composix l/p mesh (device 1) was placed and sutured.Another hernia was identified on subxiphoid region and its contents were reduced.A composix l/p mesh (device 2) was placed and sutured.¿ (b)(6) 2010 - patient was diagnosed with recurrent right lower quadrant ventral hernia, adhesions and abdominal pain thereby underwent open repair with excision of composix l/p (device 1) and implant of biological mesh.Per op notes, ¿dense adhesions present between the recurrent hernia on the rlq were taken down.A large hernia sac with loops of small bowel adherent to it.Adhesions to the previously placed mesh (device 1) were taken down.The bowel contents were reduced.The hernia sac was excised.Thick scar between omentum and right upper abdominal wall were excised.The internal hernia contents were reduced.The previous mesh (device 1) was excised and removed.A biological mesh was placed and sutured.¿.
Additional Manufacturer Narrative
At this time no conclusions can be made.The patient's attorney alleges 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: h11: this supplemental emdr is submitted to document additional information provided and to correct the implant date.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-may-2008) is considered to be a best estimate.Updated fields: a2, b3, b4, b5, b7, d4 (product catalog no., corporate lot no., udi no., expiry date), d.6b (date of explant), g1, g3, g6, h2, h4, h6, h10, h11.Corrected field: d.6a (date of implant).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: Mesh - Composix L/P
• 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 ; +1(401)825-8495
• MDR Report Key: 9111990
• Report Number: 1213643-2019-09226
• Device Sequence Number: 3588177
• Product Code: FTL
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K061754
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2009
• Device Explanted Year: 2010
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/28/2026

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: 11/28/2013
• Device Catalogue Number: 0134810
• Device Lot Number: HUSE1343
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/06/2019
• Supplement Date Received by Manufacturer: 08/13/2026
• Initial Report FDA Received Date: 09/24/2019
• Supplement Report FDA Received Date: 08/28/2026
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 05/15/2008
• 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 Sex: Female