MAUDE Adverse Event Report: ETHICON INC. VCL CT BRD VIO 8X24IN 2-0 S/A CT-2 CR; SUTURE, ABSORBABLE, SYNTHETIC

Catalog Number	D8691
Medical Device Problem Code	Device Contamination with Chemical or Other Material (2944)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).A manufacturing record evaluation was performed for the finished device lot, and no non-conformance's were identified.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.
Event or Problem Description
It was reported that a patient underwent an unknown procedure on an unknown date and suture was used.It was found that there had been a hair in the package before opening the package.There were no adverse consequences to the patient.No additional information was provided.
Additional Manufacturer Narrative
Product complaint # (b)(4).It was reported a foreign matter biological.A sealed box of product code d8691, lot # mjz981 was returned for evaluation.During the visual inspection of sealed box, a foreign matter (hair) was observed under film of the box.The manufacturing records were reviewed, and the manufacturing/packaging criteria were met prior to the release of this batch.According to sample condition the assignable cause of the foreign matter is a hair.

• Brand Name: VCL CT BRD VIO 8X24IN 2-0 S/A CT-2 CR
• 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: 8753441
• Report Number: 2210968-2019-83573
• Device Sequence Number: 11272286
• Product Code: GAM
• UDI-Device Identifier: 10705031030947
• UDI-Public: 10705031030947
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K022269
• 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): 06/10/2019

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: 07/31/2023
• Device Catalogue Number: D8691
• Device Lot Number: MJZ981
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/04/2019
• Initial Date Received by Manufacturer: 06/10/2019
• Supplement Date Received by Manufacturer: 09/04/2019
• Initial Report FDA Received Date: 07/02/2019
• Supplement Report FDA Received Date: 09/06/2019
• Patient Sequence Number: 1