MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US LCS/SIG REV FEM SLVE TRL 20MM; KNEE INSTRUMENT : FEMORAL TRIALS

Catalog Number 229453100

Device Problem Failure to Disconnect (2541)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 03/05/2018

Event Type  malfunction  

Manufacturer Narrative

(b)(4).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 the adaptor bolt stuck into sleeve trial.No surgical delay.

Manufacturer Narrative

Product complaint # (b)(4).

Manufacturer Narrative

Product complaint #: (b)(4).Investigation summary: examination of the returned device revealed the device is unable to be separated from the mating instrument.Depuy considers the investigation closed at this time.Should the additional information be received, the information will be reviewed and the investigation will be re-opened as necessary.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

• Brand Name: LCS/SIG REV FEM SLVE TRL 20MM
• Type of Device: KNEE INSTRUMENT : FEMORAL TRIALS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46582 0988
• Manufacturer (Section G): DEPUY ORTHOPAEDICS, INC. 1818910; 700 orthopaedic drive; warsaw IN 46582 0988
• Manufacturer Contact: chad gibson ; 700 orthopaedic drive; warsaw, IN 46582-0988 ; 5743725905
• MDR Report Key: 7376945
• MDR Text Key: 103671116
• Report Number: 1818910-2018-56242
• Device Sequence Number: 1
• Product Code: LXH
• UDI-Device Identifier: 10603295113720
• UDI-Public: 10603295113720
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Reporter Occupation: Health Professional
• Type of Report: Initial,Followup,Followup
• Report Date: 03/05/2018

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 Catalogue Number: 229453100
• Device Lot Number: TBCAC
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/26/2018
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 03/05/2018
• Initial Date FDA Received: 03/28/2018
• Supplement Dates Manufacturer Received: 04/02/2018; 08/08/2018
• Supplement Dates FDA Received: 04/04/2018; 08/29/2018
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 08/22/2012
• 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