MAUDE Adverse Event Report: DAVIS & GECK CARIBE LTD CAPROSYN; SUTURE, ABSORBABLE, SYNTHETIC, POLYGLYCOLIC AC

Model Number	GC-122
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	12/18/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
D10: concomitant product: gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y gc-122 - gc-122 caprosyn* 3-0 und 75cm v20 x36, lot# d2e1153y.Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Event or Problem Description
According to the reporter, during a veterinary procedure, it was noted that as soon as the customer took the 18 sutures out of the packaging, it tore immediately.The device was received without accompanying information.
Additional Manufacturer Narrative
Additional information: g3, h3, h6.H3 evaluation summary: medtronic conducted an investigation based upon all information received.Twenty sealed samples were available for evaluation.Visual inspection noted that a tactile and microscopic inspection of one suture was performed.The suture broke as it was being removed from the retainer.The break site of the suture was 4 1/8 inches from the needle attachment point.The suture also frayed at the needle attachment point when taking the measurement.It was reported that the suture was broken.The reported issue was confirmed.The most likely cause was determined to be manufacturing related.Internal process improvements have been initiated to mitigate this issue.The manufacturing records for each device are thoroughly reviewed prior to release to ensure that it meets all medtronic quality specifications.Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.

• Brand Name: CAPROSYN
• Common Device Name: SUTURE, ABSORBABLE, SYNTHETIC, POLYGLYCOLIC AC
• Manufacturer (Section D): DAVIS & GECK CARIBE LTD; zona franca de san isidro; santo domingo 0101 ; DR 0101
• Manufacturer (Section G): DAVIS & GECK CARIBE LTD; zona franca de san isidro; santo domingo 0101 ; DR 0101
• Manufacturer Contact: justin ellis ; 8200 coral sea st ne; mounds view, MN 55112 ; 7635265677
• MDR Report Key: 19000489
• Report Number: 9612501-2024-00860
• Device Sequence Number: 7590554
• Product Code: GAM
• UDI-Device Identifier: 10884521034426
• UDI-Public: 10884521034426
• Combination Product (Y/N): N
• Initial Reporter Country: GM
• PMA/510(K) Number: K032586
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 11/27/2024

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
• Operator of Device: Health Professional
• Device Expiration Date: 04/30/2025
• Device Model Number: GC-122
• Device Catalogue Number: GC-122
• Device Lot Number: D2E1153Y
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/16/2024
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: 11/13/2024
• Initial Report FDA Received Date: 03/28/2024
• Supplement Report FDA Received Date: 11/27/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 05/11/2022
• 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