MAUDE Adverse Event Report: ETHICON INC. LAPRA-TY ABSORBABLE X6::SUTURE CLIP; CLIP, IMPLANTABLE

Catalog Number XC200

Device Problem Positioning Failure (1158)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Type  malfunction  

Manufacturer Narrative

Product complaint # (b)(4).Additional information: h6 component code: g07002 - device not returned.This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by ethicon, or its employees that the report constitutes an admission that the product, ethicon, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.Additional information has been requested however not received.- please provide the applier product code and lot number? the applier product code is ka200 and lot number is unknown.- please confirm if there is an issue with the applier? no.If yes, please create a product complaint and provide the respective reference number(s).N/a, - what suture type and size was used? currently, unknown.- when the event occurred, was the suture placed near the hinge of the clip? currently, unknown.- were you able to lock the clip closed on the suture? no.If yes, after it closed, was the clip holding securely fixed on the suture? n/a.- was the applier checked for damaged (jaws straight and aligned)? there is no damage of the applier.- if the clip did not close/hold on the suture, was the clip used in an application where the suture was under tension? currently, unknown.- please provide the source or name of person providing answers to follow-up questions (not the person relaying/submitting answers to loc or chu).The sales rep has already known.- please perform and document the follow up attempt for product return.We regularly contact with sale rep about the device returning.Attempts to obtain the device have been made.If further details are received at a later date a supplemental medwatch will be sent.The following information was obtained: -lot number of xc200: null => te2ahs.-qty of product involved of xc200: 2 => 3.-qty to be returned of xc200: 2 => 3.Note: events reported via: mw# 2210968-2024-00355, mw# 2210968-2024-00356, mwr-02022024-0001565499.

Event Description

It was reported a patient underwent a laparoscopic procedure on an unknown date and an absorbable clip was used.The clip could not be clipped on the suture properly.Another device was used to complete the case.There were no adverse consequences to the patient.Additional information has been requested.

Manufacturer Narrative

Product complaint # (b)(4).Date sent to the fda: 2/27/2024.H6 component code: g07002 no device problem found.A review of the batch manufacturing records was conducted, and no related non-conformances were identified.H3 investigational summary: the product was returned to ethicon for evaluation.Visual inspection was conducted on the returned cartridge.Visual analysis of the returned samples revealed that xc200 cartridge (b) was received along with an opened foil, no apparent damage and, four clips loaded and one loose clip.The reload was tested for functionality with the test device.The loose clip was manually loaded and upon functional testing of the clips, the instrument loaded, retained, and deployed the clips as intended.The clips were as intended and conforms to our manufacturing requirements.As part of ethicon¿s quality process, all devices are manufactured, inspected, and released to approved specifications.The event described could not be confirmed as the clips performed without any difficulties noted.Although no product defect was identified, there may have been other circumstances or issues that occurred during the use of the device that could not be replicated during the laboratory analysis.Additional complaint information monitoring for potential safety signals is conducted through complaint trending as part of post market surveillance.This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by ethicon inc, or its employees that the report constitutes an admission that the product, ethicon inc or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.

• Brand Name: LAPRA-TY ABSORBABLE X6::SUTURE CLIP
• Type of Device: CLIP, IMPLANTABLE
• Manufacturer (Section D): ETHICON INC.; 1000 route 202; raritan NJ 08869
• Manufacturer (Section G): ETHICON INC.-SAN ANGELO; 3348 pulliam st; san angelo TX 76905
• Manufacturer Contact: elba bello ; 1000 route 202; raritan, NJ 08869 ; 9083863534
• MDR Report Key: 18630118
• MDR Text Key: 334781393
• Report Number: 2210968-2024-00884
• Device Sequence Number: 1
• Product Code: FZP
• UDI-Device Identifier: 10705031206885
• UDI-Public: 10705031206885
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K931492
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 02/27/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: XC200
• Device Lot Number: TE2AHS
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 01/15/2024
• Initial Date FDA Received: 02/02/2024
• Supplement Dates Manufacturer Received: 02/06/2024
• Supplement Dates FDA Received: 02/27/2024
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 05/16/2023
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1