MAUDE Adverse Event Report: ETHICON INC. ETHILON SUTURE 5"(13CM) 8-0 BLK; SUTURE, NONABSORBABLE, SYNTHETIC

Catalog Number	2808G
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	01/15/2019
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 that a patient underwent an unknown procedure on (b)(6) 2019 and a suture was used.During surgery, the suture was detached from the needle during continuous suturing.It was not a control release needle.The suture foil was opened and while the surgeon was about to use it and pulled the suture thread along its length the foil broke.The procedure was completed with a replacement device.There were no adverse patient consequences reported.

• Brand Name: ETHILON SUTURE 5"(13CM) 8-0 BLK
• Common Device Name: SUTURE, NONABSORBABLE, SYNTHETIC
• Manufacturer (Section D): ETHICON INC.; p.o. box 151, route 22 west; somerville NJ 08876 0151
• MDR Report Key: 8343104
• Report Number: 2210968-2019-78893
• Device Sequence Number: 1921355
• Product Code: GAR
• UDI-Device Identifier: 10705031003934
• UDI-Public: 10705031003934
• Combination Product (Y/N): N
• Initial Reporter Country: IN
• 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
• Report Date (Section B): 01/18/2019

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: 04/30/2022
• Device Catalogue Number: 2808G
• Device Lot Number: LEP489
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 01/18/2019
• Initial Report FDA Received Date: 02/15/2019
• Patient Sequence Number: 1