MAUDE Adverse Event Report: Ethicon Endo-Surgery, LLC.; STAPLE, IMPLANTABLE

Catalog Number	CDH29B
Medical Device Problem Codes	Failure to Cut (2587); Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/21/2026
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that during an unknown surgery, during the firing of the circular manual stapler, the plastic washer was not heard to break, which created confusion in the operating room and that the treating physician at the time was not sure if a correct staple formation and cut was achieved.The doctor wants to know why the plastic washer did not sound.He also comments that the cut line was not formed correctly.Was there any harm to the reported patient or user? no.Was there a significant delay? yes.How long was it delayed (minutes)? 15 minutes.
Additional Manufacturer Narrative
(b)(4).Date sent 9/25/2026.D4 batch # unk.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.The manufacturing records were reviewed and the manufacturing/packaging criteria were met prior to the release of this lot.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.

• Common Device Name: STAPLE, IMPLANTABLE
• Manufacturer (Section D): Ethicon Endo-Surgery, LLC.; 475 calle c; guaynabo 00969 ; PR 00969
• Manufacturer (Section G): Ethicon Endo-Surgery, LLC.; 475 calle c; guaynabo 00969 ; PR 00969
• Manufacturer Contact: orla o'mahony ; 475 calle c; guaynabo ; PR ; +1(303)552-6892
• MDR Report Key: 50896096
• Report Number: 3005075853-2026-07982
• Device Sequence Number: 21523001
• Product Code: GDW
• UDI-Device Identifier: 10705036015383
• UDI-Public: (01)10705036015383(17)310228(10)959D99
• Combination Product (Y/N): N
• Initial Reporter Country: MX
• PMA/510(K) Number: K983536
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Company Representative
• Type of Report: Initial

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: CDH29B
• Device Lot Number: 959D99
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Received by Manufacturer: 09/21/2026
• Initial Report FDA Received Date: 09/25/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 03/26/2026
• 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