MAUDE Adverse Event Report: SMITH & NEPHEW, INC. EVOS VOLAR PLTE 3H LEFT48MM; PLATE, FIXATION, BONE

Model Number 71158103

Device Problems Fitting Problem (2183); Blocked Connection (2888)

Patient Problems No Information (3190); No Clinical Signs, Symptoms or Conditions (4582)

Event Date 05/04/2020

Event Type  malfunction  

Event Description

It was reported that during surgery the screws wouldn't lock into plate.Opened a new set and used the contents of that s&n set.No delay reported.

Manufacturer Narrative

H10: internal complaint reference: (b)(4).Section h3, h6: the device was not returned for evaluation and the reported event could not be confirmed.A review of the manufacturing records did not reveal a manufacturing abnormality that could have caused or contributed to the reported incident.A review of complaint history revealed similar events for the listed device over the previous 36 months, but no similar events for the batch based on the historical data, this failure mode will be monitored for future complaints for any necessary corrective actions.A review of the risk management file revealed this failure mode was previously identified.The anticipated risk level is still adequate.A historical review concluded that there are no prior actions related to this product and event.At this time, we have no reason to suspect that the product failed to meet any product specifications at the time of manufacture.Some potential probable causes for this event could include a fit/ sizing issue or poor insertion technique.The contribution of the device to the reported event could not be corroborated.Based on this investigation, the need for corrective action is not indicated.Without the return of the actual product involved, our investigation could not proceed.Should the device or additional information be received, the complaint will be reopened.No further investigation is warranted for this complaint; however, we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.

• Brand Name: EVOS VOLAR PLTE 3H LEFT48MM
• Type of Device: PLATE, FIXATION, BONE
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• Manufacturer (Section G): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• Manufacturer Contact: sarah freestone ; 1450 brooks rd.
• MDR Report Key: 10101437
• MDR Text Key: 193131716
• Report Number: 1020279-2020-01900
• Device Sequence Number: 1
• Product Code: HRS
• UDI-Device Identifier: 00885556693780
• UDI-Public: 00885556693780
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K181533
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Consumer,User Facility,Company Representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 04/07/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/29/2020
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 71158103
• Device Catalogue Number: 71158103
• Device Lot Number: 19HT26261
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 04/06/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1