MAUDE Adverse Event Report: SYNTHES GMBH INSERTION HANDLE FOR 4.5MM VA-LCP CONDYLAR PLATE; CONDYLAR PLATE FIXATION IMPLANT

Catalog Number 03.231.001

Device Problem Device-Device Incompatibility (2919)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Type  malfunction  

Event Description

Device report from synthes reports an event in the (b)(6) as follows: it was reported that on an unknown date, the aiming arm wouldn¿t thread into the insertion handle.The surgeon used excessive force to try and force the aiming arm to thread into the insertion handle, which eventually led to the two items becoming stuck together.The aiming arm and insertion handle could no longer be used.The surgeon then performed a large open incision, as he was no longer able to do the procedure minimally invasive because of the product fault.This report involves one (1) insertion handle for 4.5mm va-lcp condylar plate.This is report 2 of 2 for (b)(4).

Manufacturer Narrative

Additional device product codes: hrs and hwc.Complainant part is expected to be returned for manufacturer review/ investigation, but has yet to be received.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.

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.H3, h6: part number: 03.231.001, lot number: 31p2532, manufacturing site: haegendorf, release to warehouse date: january 20, 2020.A manufacturing record evaluation was performed for the finished device lot number, and no non-conformances were identified.Product was not returned.Based on the information available, it has been determined that no corrective and 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.

• Brand Name: INSERTION HANDLE FOR 4.5MM VA-LCP CONDYLAR PLATE
• Type of Device: CONDYLAR PLATE FIXATION IMPLANT
• Manufacturer (Section D): SYNTHES GMBH; eimattstrasse 3; oberdorf 4436 ; SZ 4436
• Manufacturer (Section G): WERK HÄGENDORF (CH); im bifang 6; haegendorf 4614 ; SZ 4614
• Manufacturer Contact: kara ditty-bovard ; 1302 wright lane east; west chester, PA 19380 ; 6107195000
• MDR Report Key: 12795719
• MDR Text Key: 286505743
• Report Number: 8030965-2021-09428
• Device Sequence Number: 1
• Product Code: JDP
• UDI-Device Identifier: 07611819454385
• UDI-Public: (01)07611819454385
• Combination Product (y/n): N
• Reporter Country Code: UK
• PMA/PMN Number: K110354
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Company Representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 10/22/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/11/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: 03.231.001
• Device Lot Number: 31P2532
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 11/17/2021
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 01/17/2020
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Treatment: AIM-ARM F/VA-LCP CONDYLAR PL 4.5/5.0 R