MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer,other report with the FDA on 2019-03-01 for XENMATRIX AB UNKAA105 manufactured by Davol Inc., Sub. C.r. Bard, Inc..
[137663323]
At this time, no conclusions can be made to what extent the bard/davol xenmatrix ab(device #2) may have caused or contributed to the reported event. The cause of the patient postoperative complications cannot be determined at this time. The patient's attorney alleges subsequent surgical intervention; however, no details have been provided. No lot number has been provided therefore a review of the manufacturing records is not possible at this time. Information is limited. Should additional information be provided a supplemental emdr will be submitted. This emdr represents the bard/davol xenmatrix ab (device #2). An additional emdr was submitted to represent the bard/davol ventralex (device #1). Not returned.
Patient Sequence No: 1, Text Type: N, H10
[137663324]
The following was alleged by the patient's attorney: on (b)(6) 2016 or (b)(6) 2017: the patient underwent surgery for implant of an unspecified bard/davol ventralex (device #1) and unspecified bard/davol xenmartrixab (device #2). Ni/ni/ni:the patient had subsequent surgical intervention due to the hernia mesh device(s). The patient is making a claim for an adverse patient outcome against the bard/davol ventralex (device #1) and the xenmartrixab (device#2). The attorney alleges patient experienced emotional distress and the device was defective.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1213643-2019-01222 |
| MDR Report Key | 8383863 |
| Report Source | CONSUMER,OTHER |
| Date Received | 2019-03-01 |
| Date of Report | 2019-03-01 |
| Date Mfgr Received | 2019-02-10 |
| Date Added to Maude | 2019-03-01 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | JAN LING |
| Manufacturer Street | 100 CROSSINGS BLVD. |
| Manufacturer City | WARWICK RI 02886 |
| Manufacturer Country | US |
| Manufacturer Postal | 02886 |
| Manufacturer Phone | 8015652663 |
| Manufacturer G1 | BARD SHANNON LIMITED -3005636544 |
| Manufacturer Street | SAN GERONIMO INDUSTRIAL PARK LOT #1, ROAD #3, KM 79.7 |
| Manufacturer City | HUMACAO PR 00791 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 00791 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | XENMATRIX AB |
| Generic Name | SURGICAL MESH |
| Product Code | PIJ |
| Date Received | 2019-03-01 |
| Model Number | NA |
| Catalog Number | UNKAA105 |
| Lot Number | NI |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DAVOL INC., SUB. C.R. BARD, INC. |
| Manufacturer Address | 100 CROSSINGS BLVD. WARWICK RI 02886 US 02886 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2019-03-01 |