MAUDE Adverse Event Report: ETHICON INC. ETHILON SUT 18IN(45CM) 4-0 BLK; SUTURE, NONABSORBABLE, SYNTHETIC, POLYAMIDE

Catalog Number	1162H
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).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 device history records were reviewed and the manufacturing criteria were met prior to the release of this lot.
Event or Problem Description
It was reported that a patient underwent an unknown procedure on unknown date and suture was used.The suture broke during use.There were no adverse patient consequences reported.
Additional Manufacturer Narrative
Pc-(b)(4).It was reported performance breakage suture.An opened box with twenty-four unopened samples were returned for analysis.The issued sample was not received.During the visual inspection of thirteen unopened samples, no defects were found on the packages.Samples were opened, and the swage and attachment area were noted to be as expected.Sutures were dispensed without problems and examined along of the strand and no defects, damaged suture or suture breakage were noted.A functional test was performed and the tensile force was above the minimum requirement the manufacturing records were reviewed, and the manufacturing/packaging criteria were met prior to the release of this batch.Per the condition of the received samples, no breakage suture was noted, the tested sample meet the finished goods requirements.

• Brand Name: ETHILON SUT 18IN(45CM) 4-0 BLK
• Common Device Name: SUTURE, NONABSORBABLE, SYNTHETIC, POLYAMIDE
• Manufacturer (Section D): ETHICON INC.; p.o. box 151, route 22 west; somerville NJ 08876 0151
• MDR Report Key: 7923556
• Report Number: 2210968-2018-76186
• Device Sequence Number: 13834562
• Product Code: GAR
• UDI-Device Identifier: 10705031239456
• UDI-Public: 10705031239456
• Combination Product (Y/N): N
• Initial Reporter Country: GM
• PMA/510(K) Number: K946173
• 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,Followup
• Report Date (Section B): 09/04/2018

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: 04/30/2023
• Device Catalogue Number: 1162H
• Device Lot Number: MEB718
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/01/2018
• Initial Date Received by Manufacturer: 09/04/2018
• Supplement Date Received by Manufacturer: 10/01/2018
• Initial Report FDA Received Date: 10/01/2018
• Supplement Report FDA Received Date: 10/30/2018
• Patient Sequence Number: 1