MAUDE Adverse Event Report: ETHICON ENDO-SURGERY, LLC. ETS*ENDO ARTICU LIN CUTTER WHI; STAPLE, IMPLANTABLE

Catalog Number	ATW35
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	07/20/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).Batch number = > n56885.Investigation summary = > the analysis showed that the atw35 device was received with no apparent damage and with a tr35w reload loaded in the device.The reload was received partially fired 1/8 and with the reload lockout spring damaged.The returned device was tested for functionality with a test reload and it fired, cut and formed all the staples as intended.The device fired without any difficulties, the staple line was complete, and the staples were note to have the proper b-formed shape.The damage to the reload lockout spring is consistent with damage observed when the firing cycle is started, interrupted, released, and restarted.When firing the device make sure that the firing stroke is completed.Do not partially fire the device.Fire the device by squeezing the firing trigger completely until it rests on the closing trigger.Once the firing cycle has been initiated, it must be completed.If re-initiation of firing is resumed, the device will lock out.Firing through the lockout mechanism will break the device.The batch history record was reviewed and no defects, ncr¿s or protocols related to the complaint, were found during the manufacturing process.Please reference the instruction for use for more information.
Event or Problem Description
It was reported that during a laparoscopic appendectomy, the device was locked out at the first firing.Another device was used to complete the case.There were no adverse consequences to the patient.

• Common Device Name: STAPLE, IMPLANTABLE
• Manufacturer (Section D): ETHICON ENDO-SURGERY, LLC.; 475 calle c; guaynabo 00969
• MDR Report Key: 7895013
• Report Number: 3005075853-2018-12908
• Device Sequence Number: 1551953
• Product Code: GDW
• UDI-Device Identifier: 20705036012327
• UDI-Public: 20705036012327
• Combination Product (Y/N): N
• PMA/510(K) Number: K020779
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 08/24/2018

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: 08/02/2021
• Device Catalogue Number: ATW35
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/24/2018
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 08/24/2018
• Initial Report FDA Received Date: 09/20/2018
• Patient Sequence Number: 1