MAUDE Adverse Event Report: ETHICON INC. PDSII SUTURE 96IN (224CM) 1 VIO; SUTURE, SURGICAL, ABSORBABLE

Catalog Number	Z880G
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	12/07/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Product complaint # (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.
Event or Problem Description
It was reported a patient underwent a hand assisted colectomy on (b)(6) 2018 and suture was used.During use the needle tip broke off.The surgeon noted that he grabbed the needle by the tip and this happened the tip popped off.Case completed with another device of the same product code.There were no patient consequences reported.

• Brand Name: PDSII SUTURE 96IN (224CM) 1 VIO
• Common Device Name: SUTURE, SURGICAL, ABSORBABLE
• Manufacturer (Section D): ETHICON INC.; p.o. box 151, route 22 west; somerville NJ 08876 0151
• MDR Report Key: 8226512
• Report Number: 2210968-2019-78258
• Device Sequence Number: 11329560
• Product Code: NEW
• UDI-Device Identifier: 10705031061903
• UDI-Public: 10705031061903
• Combination Product (Y/N): N
• Initial Reporter State: NC
• Initial Reporter Country: US
• PMA/510(K) Number: N18331
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,user f
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 12/11/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 09/30/2023
• Device Catalogue Number: Z880G
• Device Lot Number: ML5905
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 12/11/2018
• Initial Report FDA Received Date: 01/08/2019
• Patient Sequence Number: 1