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

Catalog Number	5950020
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); Hernia (2240); Injury (2348)
Date of Event	01/19/2017
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
At this time no conclusions can be made to what extent the bard/davol ventrio (device #2) may have caused or contributed to the reported event.The attorney alleges that the patient had subsequent surgical intervention; however, no details have been provided.The cause of the patient postoperative complications cannot be determined at this time.No lot number has been provided therefore a review of the manufacturing records is not possible at this time.Should additional information be provided a supplemental emdr will be submitted.This emdr represents the bard/davol ventrio (device #2).An additional emdr was submitted to represent the bard/davol ventralight st (device #1).Not returned.
Event or Problem Description
Attorney alleges per short form (see attached) that the patient underwent surgery for implant of an unspecified bard/davol ventralight st(device #1) or an unspecified bard/davol ventrio patch(device #2) on (b)(6) 2016 or (b)(6) 2017.It is alleged that the patient had subsequent surgical intervention due to the hernia mesh device(s).As reported, the patient is making a claim for an adverse patient outcome against the bard/davol ventralight st(device #1) and the ventrio patch(device #2).As reported, the attorney alleges patient experienced emotional distress and the device was defective.
Additional Manufacturer Narrative
At this time no conclusions can be made to what extent the bard/davol ventrio(device #2) may have caused or contributed to the reported event.The attorney alleges that the patient had subsequent surgical intervention; however, no details have been provided.The cause of the patient postoperative complications cannot be determined at this time.No lot number has been provided therefore a review of the manufacturing records is not possible at this time.Addendum: h11: this supplemental emdr is submitted to document additional information provided and to correct the brand name and 510(k).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-feb-2016) is considered to be a best estimate.This emdr represents the bard/davol ventrio st mesh (device #1).An additional emdr was submitted to represent the bard/davol ventralight st using echo ps (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.
Event or Problem Description
Attorney alleges per short form (see attached) that the patient underwent surgery for implant of an unspecified bard/davol ventralight st (device #1) or an unspecified bard/davol ventrio patch (device #2) on (b)(6) 2016 or (b)(6) 2017.It is alleged that the patient had subsequent surgical intervention due to the hernia mesh device(s).As reported, the patient is making a claim for an adverse patient outcome against the bard/davol ventralight st (device #1) and the ventrio patch (device #2).As reported, the attorney alleges patient experienced emotional distress and the device was defective.Addendum per additional information provided: (b)(6) 2016 - patient was diagnosed with incisional hernia thereby underwent laparoscopic repair with implant of ventrio st mesh (device #1).Per op notes, "a ventrio st mesh (device #1) was placed and tacked." (b)(6) 2017 - patient was diagnosed with recurrent incisional hernia and adhesions thereby underwent laparoscopic repair with implant of ventralight st using echo ps (device #2).Per op notes, "adhesions were lysed and a ventralight st using echo ps (device #2) was placed and tacked." (b)(6) 2018 - patient was diagnosed with adhesions and abdominal pain thereby underwent laparoscopic lysis of adhesions.Per op notes, "adhesions found to the previously placed mesh (device #1 & #2) were taken down.".

• 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: 9365452
• Report Number: 1213643-2019-11475
• Device Sequence Number: 16951811
• Product Code: FTL
• UDI-Device Identifier: 00801741031519
• UDI-Public: (01)00801741031519(17)180228(10)HUAP2183
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• PMA/510(K) Number: K101920
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2016
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/25/2025

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: 02/28/2018
• Device Catalogue Number: 5950020
• Device Lot Number: HUAP2183
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/11/2019
• Supplement Date Received by Manufacturer: 06/11/2025
• Initial Report FDA Received Date: 11/22/2019
• Supplement Report FDA Received Date: 06/25/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 02/15/2016
• 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: 60 YR
• Patient Sex: Female