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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDOS INTERNATIONAL SàRL STERILE LATARJET SCREW, 40MM; POLYMETHYLMETHACRYLATE BONE CEMENT

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MEDOS INTERNATIONAL SàRL STERILE LATARJET SCREW, 40MM; POLYMETHYLMETHACRYLATE BONE CEMENT Back to Search Results
Model Number 288228
Device Problem Component Missing (2306)
Patient Problem No Consequences Or Impact To Patient (2199)
Event Date 09/23/2019
Event Type  malfunction  
Manufacturer Narrative
Device is not distributed in the united states, but is similar to device marketed in the usa.The investigation could not be completed; no conclusion could be drawn, as no product was received.Based on the information available, it has been determined that no corrective and/or preventative action is proposed.This complaint will be accounted for and monitored via post market surveillance activities.If additional information is made available, the investigation will be updated as applicable.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
Device report from synthes reports an event in (b)(6) as follows: it was reported that on (b)(6) 2019, that when opening the implant box (sealed and hermetic), the nurse discovered the screw was missing inside the package.There was no clinical consequence this report is for one (1) sterile latarjet screw, 40mm.This is report 1 of 1 for (b)(4).
 
Manufacturer Narrative
Product complaint # (b)(4).Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.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.Additional information: event description udi: (b)(4).
 
Event Description
Additional information received from the affiliate reported the secondary packaging was a blister and the device package was sealed.It was also reported the shoulder surgery under arthroscopy was successfully completed and patient harm was not reported.The affiliate reported the procedure was completed with another device and surgical intervention is not planned.
 
Event Description
Additional information received: name of the procedure: shoulder surgery under arthroscopy.No impact to the patient as another device was opened.The surgery was successfully completed.
 
Manufacturer Narrative
Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.Device was used for treatment, not diagnosis.Additional narrative: device evaluated by mfr: the complaint device package is not being returned, therefore unavailable for a physical evaluation.This complaint cannot be confirmed.One possible root cause of the reported problem could be improper packaging.However without the return of the complaint device package, and no further information provided we cannot determine a definitive root cause.A manufacturing record evaluation was performed for the finished device lot number (3922293), and no non-conformances were identified.At this point in time, no corrective action is required, and no further action is warranted.However, depuy synthes mitek will continue to track any related complaints within this device family as a means of monitoring the extent with which this complaint is observed in the field.Device history lot: product code: 288228, lot number: 3922293.Anomalies or discrepancies (non-conformance) : none 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.
 
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Brand Name
STERILE LATARJET SCREW, 40MM
Type of Device
POLYMETHYLMETHACRYLATE BONE CEMENT
Manufacturer (Section D)
MEDOS INTERNATIONAL SàRL
chemin-blanc 38
le locle 02400
SZ  02400
MDR Report Key9218465
MDR Text Key206751639
Report Number1221934-2019-59149
Device Sequence Number1
Product Code NDN
UDI-Device Identifier10886705027057
UDI-Public(01)10886705027057
Combination Product (y/n)N
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type foreign,health professional
Type of Report Initial,Followup,Followup
Report Date 09/25/2019
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Expiration Date08/31/2021
Device Model Number288228
Device Catalogue Number288228
Device Lot Number3922293
Was Device Available for Evaluation? No
Initial Date Manufacturer Received 09/25/2019
Initial Date FDA Received10/22/2019
Supplement Dates Manufacturer Received11/19/2019
12/22/2019
Supplement Dates FDA Received12/16/2019
12/23/2019
Patient Sequence Number1
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