BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    V-LOC 90

    MDR report key: 20519366 · Received October 23, 2024

    Report

    Report Number
    1219930-2024-05022
    Event Type
    Malfunction
    Date Received
    October 23, 2024
    Date of Event
    October 10, 2024
    Report Date
    October 23, 2024
    Manufacturer
    COVIDIEN LP LLC NORTH HAVEN
    Product Code
    GAM
    UDI-DI
    10884521131699
    PMA / PMN Number
    K100257
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CT, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    D10. CONCOMITANT MEDICAL PRODUCTS: VLOCM0024, VLOCM0024 V-LOC* 90 3-0 CLR 45CM P12X12 (LOT#A4D2109VFY); VLOCM0024, VLOCM0024 V-LOC* 90 3-0 CLR 45CM P12X12 (LOT#A4D2109VFY); VLOCM0024, VLOCM0024 V-LOC* 90 3-0 CLR 45CM P12X12 (LOT#A4D2109VFY) MEDTRONIC SUBMITS THIS REPORT TO COMPLY WITH FDA REGULATIONS 21 CFR PARTS 4 AND 803. MEDTRONIC HAS MADE REASONABLE EFFORTS TO PROVIDE AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. MEDTRONIC WILL SUBMIT A SUPPLEMENTAL REPORT IF ADDITIONAL RELEVANT INFORMATION BECOMES KNOWN.

    Description of Event or Problem · 0

    ACCORDING TO THE REPORTER, DURING A MASTOPEXY PROCEDURE, ON FOUR DEVICES, WHILE SUTURING, THE THREAD BREAKS IN THE MIDDLE. TO RESOLVE THE ISSUE, ANOTHER BOX OF DEVICES WAS USED. THERE WAS NO PATIENT INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1352065 V-LOC 90 SUTURE, ABSORBABLE, SYNTHETIC, POLYGLYCOLIC AC GAM COVIDIEN LP LLC NORTH HAVEN VLOCM0024 A4D2109VFY 10884521131699

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Female