MAUDE Adverse Event Report: ETHICON INC. VICRYL PLUS SUTURE 36"(90CM) 2-0 UND; SUTURE, ABSORBABLE, SYNTHETIC

Catalog Number	VCP917H
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Wound Dehiscence (1154); Pain (1994)
Date of Event	09/13/2018
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).The device history records were reviewed and the manufacturing criteria was met prior to the release of this lot.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 following additional information was requested but unavailable: the patient demographic info: weight, bmi at the time of index procedure.What was the tissue location of the placement of suture? what was the tissue condition, i.E., normal or thin, calcified, fragile, diseased? how was suture initially placed (interrupted or continuous)? can you explain ¿treat wound in normal process¿? what medical intervention was indicated to treat the split wound? was the suture found intact and the suture pulled away from the tissue? how was the wound closed? will product be returned, return date, tracking information.What is physician¿s opinion as to the etiology of or contributing factors to this event? what is the patient current status?.
Event or Problem Description
It was reported that the patient underwent delivery on (b)(6) 2018 and suture was used.On (b)(6) 2018, the patient went to the hospital and complained of pain.After check, the wound was found split and the nurse treated the wound accordingly.No additional information was provided.

• Brand Name: VICRYL PLUS SUTURE 36"(90CM) 2-0 UND
• Common Device Name: SUTURE, ABSORBABLE, SYNTHETIC
• Manufacturer (Section D): ETHICON INC.; p.o. box 151, route 22 west; somerville NJ 08876 0151
• MDR Report Key: 8203706
• Report Number: 2210968-2018-78073
• Device Sequence Number: 1657432
• Product Code: GAM
• UDI-Device Identifier: 10705031056039
• UDI-Public: 10705031056039
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K032420
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2018
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 12/06/2018

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?: No
• Operator of Device: Health Professional
• Device Expiration Date: 05/31/2021
• Device Catalogue Number: VCP917H
• Device Lot Number: KG2056
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 12/06/2018
• Initial Report FDA Received Date: 12/28/2018
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention