MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2020-03-26 for VCL CT BRD UD 18IN 5-0 S/A P-1 PRIME V490H manufactured by Ethicon Inc..
[188520905]
(b)(4). A manufacturing record evaluation was performed for the finished device pam853 batch number, and no non-conformances were identified. Attempts are made to obtain the device return 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. The device event of 2nd suture broke during same suturing procedure submitted via medwatch 2210968-2020-02396.
Patient Sequence No: 1, Text Type: N, H10
[188520906]
It was reported that the patient underwent an unknown ent procedure on (b)(6) 2020 and the suture was used. The needle broke during suturing. No further information is available.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2210968-2020-02397 |
| MDR Report Key | 9884590 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-03-26 |
| Date of Report | 2020-03-02 |
| Date of Event | 2020-02-24 |
| Date Mfgr Received | 2020-03-02 |
| Device Manufacturer Date | 2019-01-09 |
| Date Added to Maude | 2020-03-26 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | KARA DITTY-BOVARD |
| Manufacturer Street | P.O. BOX 151, ROUTE 22 WEST |
| Manufacturer City | SOMERVILLE NJ 08876 |
| Manufacturer Country | US |
| Manufacturer Postal | 08876 |
| Manufacturer Phone | 6107428552 |
| Manufacturer G1 | ETHICON INC.-JUAREZ |
| Manufacturer Street | AVENIDA DE LAS TORRES 7125 COL SALVACAR |
| Manufacturer City | CIUDAD JUAREZ 32604 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 32604 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VCL CT BRD UD 18IN 5-0 S/A P-1 PRIME |
| Generic Name | SUTURE, ABSORBABLE, SYNTHETIC |
| Product Code | GAM |
| Date Received | 2020-03-26 |
| Catalog Number | V490H |
| Lot Number | PAM853 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ETHICON INC. |
| Manufacturer Address | P.O. BOX 151, ROUTE 22 WEST SOMERVILLE NJ 08876 US 08876 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-03-26 |