| Brand Name | PROLENE |
| Common Device Name | suture, nonabsorbable, synthetic, polypropylene |
| Manufacturer (Section D) |
| Ethicon Inc. |
| 1000 route 202 |
| raritan NJ 08869 |
|
| Manufacturer (Section G) |
| Ethicon Inc.-San Lorenzo PR |
| road 183, km 8.3 |
|
| san lorenzo PR 00754 |
|
PR
00754
|
|
| Manufacturer Contact |
|
orla
o'mahony
|
| 1000 route 202 |
| raritan, NJ 08869
|
|
+1(303)552-6892
|
|
| MDR Report Key | 50237742 |
| Report Number | 2210968-2026-08103 |
| Device Sequence Number | 10365102 |
| Product Code |
GAW
|
| UDI-Device Identifier | 10705031045927 |
| UDI-Public | (01)10705031045927(17)300228(10)1074L2 |
| Combination Product (Y/N) | N |
| Initial Reporter State | OH |
| Initial Reporter Country | US |
| PMA/510(K) Number | K133356 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,User Facility,Company Representative |
| Type of Report
| Initial |
| Report Date (Section B) |
08/13/2026 |
| 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 Catalogue Number | M8726 |
| Device Lot Number | 1074L2 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/21/2026 |
| Initial Report FDA Received Date | 08/13/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 03/17/2025 |
| 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 |
| Patient Sex | Unknown |
|
|