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); Purulent Discharge (1812); Unspecified Infection (1930); Pain (1994); Injury (2348); Disability (2371)
Date of Event	09/17/2010
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
At this time no conclusions can be made.The patient's attorney alleges "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"; 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 #2).An additional emdr was submitted to represent the bard/davol mesh - composix kugel (device #1).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 kugel hernia patch and composix l/p on (b)(6) 2010.As reported, the patient is making a claim for an adverse patient outcome against both the devices.It is alleged that the patient sustained injuries on (b)(6) 2010 due to the hernia mesh device.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".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 "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"; 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-2010) is considered to be a best estimate.Updated fields: a2, b2, b3, b4, b5, b7, d3, d4, d.6a (date of implant), d.6b (date of explant), g3, g6, h2, h4, h6, h10.This supplemental emdr represents the composix l/p mesh (device 2).An additional supplemental emdr was submitted to represent the bard/davol composix kugel mesh (device 1).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 kugel hernia patch and composix l/p on (b)(6) 2010 and/or (b)(6) 2010.As reported, the patient is making a claim for an adverse patient outcome against both the devices.It is alleged that the patient sustained injuries on (b)(6) 2010 due to the hernia mesh device.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".It is also alleged that the patient experienced emotional distress and the device was defective.Addendum per additional information provided: on (b)(6) 2010 - patient was diagnosed with ventral hernia with adhesion thereby underwent laparoscopic repair with implant of composix kugel patch (device 1).Per operative notes, ¿an incision was made in the left upper quadrant.The hernia sac was dissected out.All adhesions were taken down.A large composix kugel patch (device 1) was placed into the defect and closed with sutures.¿ on (b)(6) 2010 - patient was diagnosed with recurrent ventral hernia, abdominal pain, adhesion thereby underwent laparoscopic repair with implant of composix l/p mesh (device 2).Per operative notes, ¿an incision was made in the left upper quadrant.The hernia sac was dissected out.All adhesions were taken down.A composix l/p mesh (device 2) was placed into the defect and secure it with sutures.¿ on (b)(6) 2010 - patient was diagnosed with abdominal pain, infected mesh, adhesion, purulent fluid thereby underwent laparoscopic repair with explant of composix kugel patch (device 1) and composix l/p mesh (device 2).Per operative notes, ¿a midline incision was made and cut down to the previously placed grafts.There was purulent fluid present which was drained.Adhesions were taken down.Previously placed composix kugel patch (device 1) and composix l/p mesh (device 2) were excised entirely.The defect was closed with sutures primarily.¿.

• 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 ; 4018258495
• MDR Report Key: 9966065
• Report Number: 1213643-2020-03499
• Device Sequence Number: 3676245
• Product Code: FTL
• UDI-Device Identifier: 00801741031311
• UDI-Public: (01)00801741031311(17)150528(10)HUUD0903
• Combination Product (Y/N): N
• Initial Reporter State: RI
• Initial Reporter Country: US
• PMA/510(K) Number: K061754
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2010
• 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): 12/26/2025

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: 05/28/2015
• Device Catalogue Number: 0134810
• Device Lot Number: HUUD0903
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/02/2020
• Supplement Date Received by Manufacturer: 12/05/2025
• Initial Report FDA Received Date: 04/15/2020
• Supplement Report FDA Received Date: 12/26/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 04/15/2010
• 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: 53 YR
• Patient Sex: Female