MAUDE Adverse Event Report: SYNTHES GMBH VA LOCKING SCREW STARDRIVE® ÿ 2.7 MM (HE; APPLIANCE, FIXATION, NAIL/BLADE/PLATE COMBINATION, MULTIPLE COMPONENT

Model Number 02.211.054

Device Problem Material Deformation (2976)

Patient Problem Appropriate Clinical Signs, Symptoms, Conditions Term / Code Not Available (4581)

Event Date 05/29/2022

Event Type  Injury  

Event Description

Device report from synthes reports an event in france as follows: it was reported on (b)(6) 2022 there was lack of locking of 2.7 mm locking screws in two (2) low compression plate (lcp) elbow plates with a dynamometric screwdriver intraoperatively.Several screws bent and there were two (2) edges on one side.The patient was immobilized for ten (10) days and x-rays were taken.A surgical revision is planned to remove everything but has not yet been completed.Implants are still currently implanted in the patient.This is report 5 of 12 for (b)(4).This report is for a locking screw.

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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.Devices were not explanted but a revision is expected.Complainant part is not expected to be returned for manufacturer review/investigation.(udi)/pma/510k: 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.

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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H10: additional narrative: d4.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.B5: subsequent follow-up with the customer, additional information was received regarding the event.It was reported that there was unlocking of the screw relative to the plate and retraction of the screws.It was reported that the customer encountered an incident with the 2 lcp plates.It was reported that the implant had been in the patient for 10 days.It was reported that there was a cast immobilization.Investigation summary : 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 history review : part # 02.211.054ts lot # 9l15674 manufacturing site: werk selzach.Release to warehouse date: 11 mar2022 expiration date: 01 mar2027 supplier: (b)(4).A manufacturing record evaluation was performed for the finished article lot and no non-conformances were identified.Non-sterile part # 02.211.054 non-sterile lot # 589p913 manufacturing site:werk selzach.Release to warehouse date: 06 jan2022.Supplier: (b)(4).

• Brand Name: VA LOCKING SCREW STARDRIVE® ÿ 2.7 MM (HE
• Type of Device: APPLIANCE, FIXATION, NAIL/BLADE/PLATE COMBINATION, MULTIPLE COMPONENT
• Manufacturer (Section D): SYNTHES GMBH; eimattstrasse 3; oberdorf 4436 ; SZ 4436
• Manufacturer (Section G): SYNTHES SELZACH; bohackerweg 5; selzach 2545 ; SZ 2545
• Manufacturer Contact: kate karberg ; 1302 wright lane east; west chester, PA 19380 ; 3035526892
• MDR Report Key: 14959600
• MDR Text Key: 295526642
• Report Number: 8030965-2022-04666
• Device Sequence Number: 1
• Product Code: KTT
• UDI-Device Identifier: 10886982053787
• UDI-Public: (01)10886982053787
• Combination Product (y/n): N
• Reporter Country Code: FR
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/08/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 02.211.054
• Device Catalogue Number: 02.211.054TS
• Device Lot Number: 9L15674
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 08/02/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 03/11/2022
• Is the Device Single Use?: Yes
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Treatment: LOCKSCR ø3.5 SELF-TAP L22 SST; LOCKSCR ø3.5 SELF-TAP L22 SST; LOCKSCR ø3.5 SELF-TAP L26 SST; VA LOCKING SCREW STARDRIVE; VA LOCKING SCREW STARDRIVE® à 2.7 MM (HE; VA LOCKING SCREW STARDRIVE® à 2.7 MM (HE; VA LOCKING SCREW STARDRIVE® à 2.7 MM (HE; VA LOCKING SCREW STARDRIVE® à 2.7 MM (HE; VA LOCKING SCREW STARDRIVE® à 2.7 MM (HE; VA-LCP DHP 2.7/3.5 LAT LE MED 2HO L82 SS; VA-LCP DHP 2.7/3.5 MED LE LONG 4HO L108
• Patient Outcome(s): Required Intervention