MAUDE Adverse Event Report: ETHICON INC. VCL CT BRD UD 27IN 1 S/A CP-1; SUTURE, ABSORBABLE, SYNTHETIC

Model Number	J268H
Medical Device Problem Code	Material Separation (1562)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/22/2021
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that a patient underwent a c-section procedure on (b)(6) 2021 and suture was used.During the procedure, the needle and thread became separated.There were no patient consequences reported.Additional information was requested.
Additional Manufacturer Narrative
Product complaint # (b)(4).If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.Additional information was requested, and the following was obtained: were x-rays taken to locate the needle? a: no required.Surgeon saw both needle and suture immediately and recovered both.Was there any patient consequence or injury? a: patient doing fine.What medical/surgical intervention was provided? a: no medical intervention required.What is the condition of the patient? a: patient and baby are fine.Will device be coming back? a: no.Both needle and suture were blood contaminated and disposed accordingly.Attempts have been made to retrieve the device.To date the device has not been returned.If the device or further details are received at a later date a supplemental medwatch will be sent.A manufacturing record evaluation was performed for the finished device lot, and no non-conformances were identified.
Additional Manufacturer Narrative
Product complaint # (b)(4).If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.Additional information was requested, and the following was obtained: were x-rays taken to locate the needle? a: no required.Surgeon saw both needle and suture immediately and recovered both.Was there any patient consequence or injury? a: patient doing fine.What medical/surgical intervention was provided? a: no medical intervention required.What is the condition of the patient? a: patient and baby are fine.Will device be coming back? a: no.Both needle and suture were blood contaminated and disposed accordingly.Attempts have been made to retrieve the device.To date the device has not been returned.If the device or further details are received at a later date a supplemental medwatch will be sent.A manufacturing record evaluation was performed for the finished device lot, and no non-conformances were identified.
Event or Problem Description
It was reported that a patient underwent a c-section procedure on (b)(6) 2021 and suture was used.During the procedure, the needle and thread became separated.There were no patient consequences reported.Additional information was requested.

• Brand Name: VCL CT BRD UD 27IN 1 S/A CP-1
• Common Device Name: SUTURE, ABSORBABLE, SYNTHETIC
• Manufacturer (Section D): ETHICON INC.; 1000 route 202; raritan NJ 08869
• Manufacturer (Section G): ETHICON INC.-JUAREZ; avenida de las torres 7125; col salvacar; cuidad juarez ; MX
• Manufacturer Contact: elba bello ; 1000 route 202; raritan, NJ 08869
• MDR Report Key: 12852120
• Report Number: 2210968-2021-11855
• Device Sequence Number: 4840174
• Product Code: GAM
• UDI-Device Identifier: 10705031038417
• UDI-Public: 10705031038417
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K022269
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 11/22/2021

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
• Operator of Device: Health Professional
• Device Expiration Date: 10/31/2021
• Device Model Number: J268H
• Device Catalogue Number: J268H
• Device Lot Number: KMZ680
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/25/2021
• Initial Report FDA Received Date: 11/22/2021
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/16/2016
• 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
• Patient Sex: Unknown