BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD, DAVOL INC.

    MDR report key: 2074967 · Received April 27, 2011

    Report

    Report Number
    MW5020420
    Event Type
    Injury
    Date Received
    April 27, 2011
    Date of Event
    March 23, 2011
    Report Date
    April 27, 2011
    Manufacturer
    BARD, DAVOL INC.
    Product Code
    FTL
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    I WAS IMPLANTED A XENMATRIX SURGICAL GRAFT AT THE CLEVELAND CLINIC BY DR (B)(6) TO REPAIR A HERNIA VENTRAL. I WAS IN HOSP FROM (B)(6) 2011. DUE TO HIGH FEVER OF 103 DEGREES FAHRENHEIT, I WAS READMITTED TO HOSP ON (B)(6) 2011.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD, DAVOL INC. XENMATRIX SURGICAL GRAFT FTL BARD, DAVOL INC. HUVABL14

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR Hospitalization