MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 4.5 VA-LCP CRVD COND PL/14HOLE/301/RT-S; IMPLANT, FIXATION DEVICE, CONDYLAR PLATE

Model Number 02.124.414S

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Unspecified Infection (1930)

Event Type  Injury  

Event Description

It was reported that on april 4, 2022, a hardware removal of a retrograde femoral nail -advanced system (rfna) nail construct and a variable angle (va) condylar plate construct were removed from a femur because of infection.The devices were originally implanted on february 16, 2022 and explanted on april 4, 2022.No allegations were made on the devices from the surgeon.The surgeon removed the proximal screws, and performed an amputation to remove remaining hardware on one piece.The exact total number of implanted screws removed is unknown.The procedure outcome was unknown.This is report 2 of 3 for (b)(4).This report is for a va condylar plate.

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.Event date is unknown, complainant part is not expected to be returned for manufacturer review/investigation.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 history: part #: 02.124.414s-us, lot #: l561771, manufacturing site: (b)(4), release to warehouse date: 20 sep 2017, expiration date: n/a.A manufacturing record evaluation was performed for the finished device lot number, and no non-conformances were identified.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: 4.5 VA-LCP CRVD COND PL/14HOLE/301/RT-S
• Type of Device: IMPLANT, FIXATION DEVICE, CONDYLAR PLATE
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• Manufacturer (Section G): WERK MEZZOVICO (CH); via cavazz 5; mezzovico 6805 ; SZ 6805
• Manufacturer Contact: kate karberg ; 1302 wrights lane east; west chester, PA 19380 ; 6107195000
• MDR Report Key: 14270405
• MDR Text Key: 292060161
• Report Number: 2939274-2022-01581
• Device Sequence Number: 1
• Product Code: JDP
• UDI-Device Identifier: 10886982042903
• UDI-Public: (01)10886982042903
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K110354
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/03/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 02.124.414S
• Device Catalogue Number: 02.124.414S
• Device Lot Number: L561771
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 04/04/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 09/20/2017
• Is the Device Single Use?: Yes
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Treatment: RFNA / 11 / 240 5 DEG BEND / STERILE; UNK - SCREWS: NAIL PROXIMAL LOCKING
• Patient Outcome(s): Required Intervention
• Patient Sex: Female
• Patient Weight: 52 KG