MAUDE Adverse Event Report: DEPUY FRANCE SAS - 3003895575 HO NECK SEGMENT COR AMT; HIP INSTRUMENTS : FEMORAL TRIALS

Model Number	L20433
Medical Device Problem Codes	Device-Device Incompatibility (2919); Material Integrity Problem (2978)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	05/25/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Product complaint # (b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Event or Problem Description
The surgeons was attempting to trial the high offset neck trial on the size 12 broach as per normal procedure, but was unable to seat the trial neck on the size 12 broach.After being unable to trial the neck, the surgeon then had to implant the definitive stem and then trial off that.Upon investigation by the team after the case, they could see that the adaptor on the broach may be damaged preventing the neck trial from seating.They also tried the std neck trial to confirm, and this was hard to seat on the broach too.No rep was present at the case.
Additional Manufacturer Narrative
Product complaint #: (b)(4).Investigation summary: the device was reviewed by depuy engineering melbourne in a-4281685 which states my assessment is that this complaint is due to wear and tear.Root cause attributed to the device being worn from normal use and servicing.Depuy synthes considers the investigation closed at this time.Should additional information be received, the information will be reviewed and the investigation may be re-opened as necessary.
Additional Manufacturer Narrative
Product complaint # (b)(4).Investigation summary: no device associated with this report was received for examination.A worldwide lot specific complaint database search, or device history record (dhr) review was not possible because the required lot code(s) was not provided.Based on previous investigations this complication of joint replacement is unlikely to have been the result of a device failing to meet required specifications.The information received will be retained for potential series investigations if triggered by trend analysis, post market surveillance, or other events within the quality system.Corrective action was not indicated.
Additional Manufacturer Narrative
Product complaint # (b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes joint reconstruction, or its employees that the report constitutes an admission that the product, depuy synthes joint reconstruction, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.

• Brand Name: HO NECK SEGMENT COR AMT
• Common Device Name: HIP INSTRUMENTS : FEMORAL TRIALS
• Manufacturer (Section D): DEPUY FRANCE SAS - 3003895575; 7 allee irene joliot-curie; b.p. 256; saint priest cedex 69801 ; FR 69801
• MDR Report Key: 10135642
• Report Number: 1818910-2020-13523
• Device Sequence Number: 19561068
• Product Code: LXH
• UDI-Device Identifier: 10603295258230
• UDI-Public: 10603295258230
• Combination Product (Y/N): N
• Initial Reporter Country: NZ
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 05/25/2020

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
• Operator of Device: Health Professional
• Device Model Number: L20433
• Device Catalogue Number: L20433
• Device Lot Number: 5064961
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 05/25/2020
• Supplement Date Received by Manufacturer: 07/03/2020; 07/17/2020; 07/23/2020
• Initial Report FDA Received Date: 06/09/2020
• Supplement Report FDA Received Date: 07/06/2020; 07/21/2020; 07/24/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1