MAUDE MDR 9908223

MDR report key
9908223
Report number
2210968-2020-02500
Event key
0
Event type
3
Date of event
2020-03-02
Date received
2020-03-31
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
KARA DITTY-BOVARD
Address
P.O. BOX 151, ROUTE 22 WEST SOMERVILLE NJ 08876 US
Phone
610-610-6107
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PROLENE*BLUE 3-0 45CM (1)SC-24SUTURE, NONABSORBABLE, SYNTHETIC, POLYPROPYLENEETHICON INC.GAW8184TAM5324R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-03-3101. R

Event Narratives#

N

Patient 1

(B)(4). A MANUFACTURING RECORD EVALUATION WAS PERFORMED FOR THE FINISHED DEVICE, AND NO NON-CONFORMANCES WERE IDENTIFIED. 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 PATIENT DEMOGRAPHIC INFO: AGE, GENDER, WEIGHT, BMI AT THE TIME OF INDEX PROCEDURE ON WHAT TISSUE WHAT THE SUTURE USED? WHAT WAS THE TISSUE CONDITION, I.E. NORMAL OR THIN, CALCIFIED, FRAGILE, DISEASED? WHAT INSTRUMENTS WERE USED TO GRASP THE NEEDLE? WHERE WAS THE NEEDLE GRASPED DURING USE? WAS THE ENTIRE DEVICE REMOVED FROM THE PATIENT ON (B)(6) 2020? DOES THE PIECE/DEVICE REMAIN RETAINED IN THE PATIENT?S TISSUE? IF THE PIECES WERE RETAINED, WHERE IS THE DEVICE LOCATED/IN WHAT STRUCTURE? OTHER RELEVANT PATIENT HISTORY/CONCOMITANT MEDICATIONS. WILL THE ACTUAL DEVICE BE RETURNED FOR EVALUATION? WILL REPRESENTATIVE SAMPLES FROM THE SAME LOT BE RETURNED FOR EVALUATION? WHAT IS PHYSICIAN?S OPINION AS TO THE ETIOLOGY OF OR CONTRIBUTING FACTORS TO THIS EVENT?

D

Patient 1

IT WAS REPORTED THAT THE PATIENT UNDERWENT A C-SECTION PROCEDURE ON (B)(6) 2020 AND THE SUTURE WAS USED FOR SKIN CLOSURE. WHILE AT THE RIGHT ANGLE OF A SURGICAL WOUND, THERE WAS A RUPTURE/BREAKAGE OF THE NEEDLE IN THE PROXIMAL THIRD. IT WAS ALSO REPORTED THAT MORE THAN HALF THE NEEDLE WAS RETAIN IN THE PATIENT. EXPLORATION OF THE SURGICAL WOUND WAS PERFORMED WITH SOFT TISSUE ULTRASOUND AND RX INTRAOPERATIVE ABDOMEN WITHOUT FINDING THE NEEDLE. IT WAS REPORTED THAT THE PATIENT HAD TO BE RE-OPERATED ON (B)(6) 2020 IN ORDER TO EXTRACT THE NEEDLE WHICH WAS FOUND IN THE SUBCUTANEOUS TISSUE. THE PATIENT HAD TO STAY ONE MORE DAY IN THE HOSPITAL. THE PATIENT WAS WELL AND RELEASED ON (B)(6) 2020. ADDITIONAL INFORMATION HAS BEEN REQUESTED.