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

Model Number	2808G
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	02/18/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).Attempts are being made to receive the device for evaluation.To date the device has not been returned.If the device or further details are received at the later date a supplemental medwatch will be sent.
Event or Problem Description
It was reported that the patient underwent a glossectomy oral surgery on (b)(6) 2020 and the suture was used.It was reported that the suture snapped during the surgery.Another like suture used to complete the surgery.There was no adverse patient consequence reported.
Additional Manufacturer Narrative
(b)(4).A manufacturing record evaluation was performed for the finished device batch pjr835, and no non-conformances were identified.Additional h3 investigation summary: unopened samples were returned for analysis.The complaint sample was not received.During the visual inspection of eleven unopened samples, no defects were found on the packages.The samples were opened, and the swage and attachment area were noted to be as expected.The sutures were dispensed without problems and examined along of the strand and no defects, damaged or suture breakage were noted.A functional test was performed and the tensile strength 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 samples received, no performance - breakage suture was found and the tested samples met the finished goods requirements.

• 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
• MDR Report Key: 9832992
• Report Number: 2210968-2020-02090
• Device Sequence Number: 19590413
• Product Code: GAR
• UDI-Device Identifier: 10705031003934
• UDI-Public: 10705031003934
• Combination Product (Y/N): N
• Initial Reporter Country: AS
• 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): 02/20/2020

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: 07/31/2024
• Device Model Number: 2808G
• Device Catalogue Number: 2808G
• Device Lot Number: PJR835
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/19/2020
• Initial Date Received by Manufacturer: 02/20/2020
• Supplement Date Received by Manufacturer: 03/19/2020
• Initial Report FDA Received Date: 03/14/2020
• Supplement Report FDA Received Date: 04/13/2020
• Patient Sequence Number: 1