MAUDE Adverse Event Report: COVIDIEN SURGICAL POLYSORB; SUTURE, ABSORBABLE, SYNTHETIC, POLYGLYCOLIC AC

Model Number	GL-122
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Codes	Wound Dehiscence (1154); Purulent Discharge (1812); Erythema (1840); Inflammation (1932); Pain (1994); Swelling/ Edema (4577)
Date of Event	11/20/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
According to the reporter, on (b)(6) 2025, a live infant was delivered via spontaneous vaginal delivery which was routinely closed with synthetic absorbable surgical suture.Intrapartum bleeding was approximately 250 ml.Postpartum, uterotonic therapy and other treatments were given.On the fourth day after delivery, the patient complained of significant pain at the perineal laceration suture site.Physical examination revealed partial dehiscence of the perineal suture, mild redness and swelling, a small amount of pale yellow exudate on the surface and broken perineal sutures.Disinfection and dressing changes were performed, and the patient was informed in detail about her condition.At the patient¿s request, drainage and debridement treatment were provided, with daily perineal debridement and dressing changes for symptomatic management, as well as intravenous antibiotics for infection control.Subsequently, a secondary debridement and suture procedure was performed at the perineal laceration site.Postoperatively, intravenous antibiotics were continued for infection control.The incision at the perineal laceration site healed well, with no redness, swelling, or exudate.
Additional Manufacturer Narrative
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.
Additional Manufacturer Narrative
Correction: g3, h6.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: POLYSORB
• Common Device Name: SUTURE, ABSORBABLE, SYNTHETIC, POLYGLYCOLIC AC
• Manufacturer (Section D): COVIDIEN SURGICAL; 60 middletown ave; north haven CT 06473
• Manufacturer (Section G): COVIDIEN SURGICAL; 60 middletown ave; north haven CT 06473
• Manufacturer Contact: mike bocchino ; 8200 coral sea st ne; mounds view, MN 55112-4391 ; 8006464633
• MDR Report Key: 23788459
• Report Number: 1219930-2025-05706
• Device Sequence Number: 10448306
• Product Code: GAM
• UDI-Device Identifier: 10884521044968
• UDI-Public: (01)10884521044968(17)300228(10)A5C1775Y(20)01
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K963253
• 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
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 12/26/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: GL-122
• Device Catalogue Number: GL-122
• Device Lot Number: A5C1775Y
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/01/2025
• Supplement Date Received by Manufacturer: 12/17/2025
• Initial Report FDA Received Date: 12/12/2025
• Supplement Report FDA Received Date: 12/26/2025
• Date Device Manufactured: 03/05/2025
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 28 YR
• Patient Sex: Female