MAUDE Adverse Event Report: DAVOL INC., SUB. C.R. BARD, INC. -1213643 MESH - COMPOSIX L/P W/ ECHO; SURGICAL MESH

Catalog Number	0144790
Medical Device Problem Codes	Defective Device (2588); Patient-Device Incompatibility (2682); Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Pain (1994); Injury (2348)
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.This emdr represents the bard/davol mesh - composix l/p (device #1).An additional emdr was submitted to represent the bard/davol mesh - ventralex (device #2).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 unspecified bard/davol composix l/p, ventralex hernia patch and ventrio patch.As reported, the patient is making a claim for an adverse patient outcome against composix l/p and ventralex hernia patch which were implanted on (b)(6) 2018.Attorney alleges that the patient had subsequent surgical intervention due to the hernia mesh device.It is also alleged that the patient experienced emotional distress and the device was defective.
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 brand name and 510k.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-mar-2016) is considered to be a best estimate.Updated fields: a2, a4, b4, b5, b6, b7, d3 (manufacturer), d4, g1, g3, g6, h2, h4, h6, h10, h11.Corrected field: d1 (brand name) and g4 (510k).This supplemental emdr represents the composix l/p using echo ps (device #2).Additional supplemental emdr was submitted to represent ventralex mesh (device #3).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 that the patient underwent surgery for implant of unspecified bard/davol composix l/p, ventralex hernia patch and ventrio patch.As reported, the patient is making a claim for an adverse patient outcome against composix l/p and ventralex hernia patch which were implanted on (b)(6) 2018.Attorney alleges that the patient had subsequent surgical intervention due to the hernia mesh device.It is also alleged that the patient experienced emotional distress and the device was defective.Addendum per additional information provided: (b)(6) 2017 - patient was diagnosed with multiple ventral incisional hernias thereby underwent open repair with implant of ventrio mesh (device #1).Per op notes, "multiple defects were connected and a ventrio mesh (device #1) was placed and sutured." (b)(6) 2018 - patient was diagnosed with recurrent ventral incisional hernia with multiple adhesions thereby underwent laparoscopic repair with implant of composix l/p using echo ps (device #2) and ventralex mesh (device #3).Per op notes, "multiple adhesions were taken down.The previous mesh (device #1) was still in place covering the defect.In the mid right side, a composix l/p using echo ps (device #2) was placed and sutured.In the left lower quadrant, a ventralex mesh (device #3) was placed and sutured.".

• Brand Name: MESH - COMPOSIX L/P W/ ECHO
• 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: 9621251
• Report Number: 1213643-2020-00506
• Device Sequence Number: 2100786
• Product Code: FTL
• UDI-Device Identifier: 00801741031366
• UDI-Public: (01)00801741031366(17)180328(10)HUAQ1576
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K122436
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2018
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 09/04/2025

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: 03/28/2018
• Device Catalogue Number: 0144790
• Device Lot Number: HUAQ1576
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/14/2020
• Supplement Date Received by Manufacturer: 08/14/2025
• Initial Report FDA Received Date: 01/23/2020
• Supplement Report FDA Received Date: 09/04/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 03/15/2016
• 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 Sex: Male