BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ECHELON 60MM REINFORCEMENT

    MDR report key: 14053414 · Received April 8, 2022

    Report

    Report Number
    3005075853-2022-02161
    Event Type
    Malfunction
    Date Received
    April 8, 2022
    Date of Event
    January 1, 2022
    Report Date
    June 23, 2022
    Manufacturer
    ETHICON ENDO-SURGERY, LLC.
    Product Code
    OXC
    UDI-DI
    10705036023296
    PMA / PMN Number
    K190937
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 0

    (B)(4). BATCH #: UNK. DATE OF EVENT: DATE OF EVENT IS 2022, EVENT DAY AND MONTH UNKNOWN. CAPTURED AS (B)(6) 2022. THE LOT/BATCH WAS NOT PROVIDED; THEREFORE, THE MANUFACTURING RECORDS EVALUATION COULD NOT BE PERFORMED. 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. IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL REPORT, A FOLLOW-UP REPORT WILL BE FILED AS APPROPRIATE.

    Additional Manufacturer Narrative · 0

    (B)(4). DATE SENT: 6/23/2022. D4: BATCH # RBCCMSS0. INVESTIGATION SUMMARY: THE PRODUCT WAS RETURNED TO ETHICON ENDO-SURGERY FOR EVALUATION. VISUAL INSPECTION WAS CONDUCTED ON THE RETURNED APPLICATOR. VISUAL ANALYSIS OF THE RETURNED SAMPLE DETERMINED THAT AN INDIVIDUAL 1-UP CARTON WAS RETURNED. THE TEMPERATURE INDICATOR STICKER ON CARTON HAD BEEN TRIGGERED AND WAS PINK, INDICATED THAT THE PACKAGE WAS SUBJECTED TO A TEMPERATURE IN EXCESS OF 50°. THE DEVICE WAS OPENED AND VISUALLY INSPECTED WAS PERFORMED FOR DAMAGE TO THE BUTTRESS ATTACHMENT MATERIAL (BAM) PATTERN AND WAS FOUND TO APPEAR CONFORMING. AS PART OF OUR QUALITY PROCESS, THE MANUFACTURING RECORDS OF THIS BATCH NUMBER WERE REVIEWED, AND THE MANUFACTURING STANDARDS WERE MET PRIOR TO THE RELEASE OF THIS BATCH. AS PART OF ETHICON ENDO SURGERY¿S QUALITY PROCESS, ALL DEVICES ARE MANUFACTURED, INSPECTED, AND RELEASED TO APPROVED SPECIFICATIONS. NO CONCLUSION COULD BE REACHED ON WHAT MAY HAVE CAUSED THE REPORTED INCIDENT. A MANUFACTURING RECORD EVALUATION WAS PERFORMED FOR THE FINISHED DEVICE BATCH NUMBER, AND NO NON-CONFORMANCES RELATED TO THE REPORTED COMPLAINT CONDITION WERE IDENTIFIED.

    Description of Event or Problem · 0

    IT WAS REPORTED BY THE SALES REP THAT 44 UNITS HAD A PINK TEMPERATURE GAUGES. NO PATIENT CONSEQUENCES REPORTED. NO FURTHER INFORMATION IS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    161683 ECHELON 60MM REINFORCEMENT OXC OXC ETHICON ENDO-SURGERY, LLC. ECH60R 10705036023296

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown