MAUDE Adverse Event Report: ETHICON INC. VICRYL PLUS SUTURE 27"(70CM) 3-0 VIO; SUTURE, ABSORBABLE, SYNTHETIC

Model Number	VCP305H
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	01/01/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).A manufacturing record evaluation was performed for the finished device pe6532 batch number, and no non-conformance's were identified.Attempts are being 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 the patient underwent an unknown procedure on an unknown date and suture was used.During the procedure the device was broken easily during use.The procedure was not delayed.There were no adverse patient consequences reported.
Additional Manufacturer Narrative
Product complaint # (b)(4).Corrected information: d3, g1, g2.Additional information: d10.H3 evaluation: representative samples returned to support investigation of multiple device issues captured in reports 2210968-2020-02265 and 2210968-2020-02266.Analysis results have been included in follow-up reports for each.Unopened samples of product were received for analysis.The complaint sample was not received.During the visual inspection of 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 the strand with no defects, damages or suture breakage 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 suture breakage was found and the tested samples met the finished goods requirements.

• Brand Name: VICRYL PLUS SUTURE 27"(70CM) 3-0 VIO
• Common Device Name: SUTURE, ABSORBABLE, SYNTHETIC
• Manufacturer (Section D): ETHICON INC.; p.o. box 151, route 22 west; somerville NJ 08876
• MDR Report Key: 9861513
• Report Number: 2210968-2020-02266
• Device Sequence Number: 14106250
• Product Code: GAM
• UDI-Device Identifier: 10705031052130
• UDI-Public: 10705031052130
• Combination Product (Y/N): N
• Initial Reporter Country: TW
• PMA/510(K) Number: K132580
• 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): 02/24/2020

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: 04/30/2024
• Device Model Number: VCP305H
• Device Catalogue Number: VCP305H
• Device Lot Number: PE6532
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/05/2020
• Initial Date Received by Manufacturer: 02/24/2020
• Supplement Date Received by Manufacturer: 05/05/2020
• Initial Report FDA Received Date: 03/20/2020
• Supplement Report FDA Received Date: 05/06/2020
• Patient Sequence Number: 1