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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC HAND PIECE FOR BATTERY POWERED DRIVER; SCREWDRIVER, SKULLPLATE

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WRIGHTS LANE SYNTHES USA PRODUCTS LLC HAND PIECE FOR BATTERY POWERED DRIVER; SCREWDRIVER, SKULLPLATE Back to Search Results
Model Number 05.000.008
Device Problem Mechanical Problem (1384)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Type  malfunction  
Manufacturer Narrative
Depuy synthese is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthese has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthese or its employees that the report constitutes an admission that the device, depuy synthese, or its employees caused or contributed to the potential event described in this report.If the information is unknown, not available or does not apply, the section/field of the form is left blank.Additional manufacturer narrative: additional device product codes: hxx, hwe.Initial reporter occupation: reporter is a j&j employee.Part # 05.000.008.Synthese lot # 005522.Supplier lot # 005522.Release to warehouse date: 02 dec2013.Supplier: triangle manufacturing.No ncrs were generated during production.Review of the device history record's showed that there were no issues during the manufacture of this product, and any sub-components, which would contribute to this complaint condition.Service and repair evaluation: the customer reported the hand piece for battery powered driver (product code: 05.000.008 and lot number: 005522) buttons are defective.The repair technician reported the device does not run in in all three modes, crack on the contact plate, and membrane vent broken.The cause of the issue is damaged component.The item will be repaired per the inspection sheet and will be returned to the customer upon completion of the service and repair process.Attached service record router complete.Finalized service record will be archived.The evaluation was confirmed.Service and repair evaluation: it was reported that the buttons of device 05.000.008, hand piece for battery powered driver are defective.The repair technician reported that device does not run in fast forward, forward and reverse conditions, contact plate was cracked, membrane vent was broken, patina on d34, barriers and d41, d50 was cracked, damaged membrane vent, rusted internal components, black and brown residue on barriers, loctite on d56, d56 was broken in d34.Warranty replaced was the reason for repair.The cause of the issue was damaged component.The item will be forwarded to customer quality.The evaluation was confirmed.The device was deemed serviceable and will be returned to the customer, no design or manufacturing issues were identified therefore it has been determined that no corrective and/or preventative action is proposed.Device was used for treatment, not diagnosis.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
 
Event Description
It was reported that during a procedure on an unknown date, the buttons of the hand piece for battery powered driver were defective.Ten devices were affected.There was no patient involvement.No further information is available.This report involves one hand piece for battery powered driver.This is report 5 of 5 for (b)(4).
 
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Brand Name
HAND PIECE FOR BATTERY POWERED DRIVER
Type of Device
SCREWDRIVER, SKULLPLATE
Manufacturer (Section D)
WRIGHTS LANE SYNTHES USA PRODUCTS LLC
1302 wrights lane east
west chester PA 19380
Manufacturer (Section G)
MONUMENT
1101 synthes avenue
monument CO 80132
Manufacturer Contact
kate karberg
1302 wright lane east
west chester, PA 19380
3035526892
MDR Report Key16101384
MDR Text Key308736201
Report Number2939274-2023-00001
Device Sequence Number1
Product Code GXL
UDI-Device Identifier10887587024585
UDI-Public10887587024585
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
EXEMPT
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Health Professional,Company Representative
Reporter Occupation Other Health Care Professional
Type of Report Initial
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received01/05/2023
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Model Number05.000.008
Device Catalogue Number05.000.008
Device Lot Number005522
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer11/05/2021
Is the Reporter a Health Professional? Yes
Date Manufacturer Received12/12/2022
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured12/02/2013
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Unknown
Patient Sequence Number1
Treatment
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