MAUDE Adverse Event Report: SMITH & NEPHEW, INC. 3.2MM T-HANDLE TROCAR; PIN, FIXATION, THREADED

Model Number	71674074
Medical Device Problem Code	Material Fragmentation (1261)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	05/19/2020
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that, during cleaning process, handle weld came apart and separated.The shaft came apart from the handle.No issues during case since the event occurred after procedure.Therefore, no delay and no backup was needed.
Additional Manufacturer Narrative
H3, h6: the device, intended for use in treatment, was returned for evaluation.A visual inspection of the returned device confirms the device has fractured at the welded junction of the shaft and the handle.Only the handle was returned for evaluation.The device shows significant signs of wear/ usage.A review of complaint history on the listed part revealed no prior complaints for the listed batch with the same failure mode.This device is a reusable instrument that can be exposed to numerous surgeries; damage from repeated use can occur.Expected wear/tear is likely the probable cause of the reported event.We recommend that all reusable instruments be routinely inspected for wear and damage and replaced as necessary.At this time, we have no reason to suspect that the product failed to meet any product specifications at the time of manufacture.Based on this investigation, the need for corrective action is not indicated.Should additional information be received, the complaints will be reopened.No further investigation is warranted for these complaints; however we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.G1.

• Brand Name: 3.2MM T-HANDLE TROCAR
• Common Device Name: PIN, FIXATION, THREADED
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• MDR Report Key: 10160242
• Report Number: 1020279-2020-02429
• Device Sequence Number: 19538936
• Product Code: JDW
• UDI-Device Identifier: 03596010560704
• UDI-Public: 03596010560704
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K120871
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 10/13/2021

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: 71674074
• Device Catalogue Number: 71674074
• Device Lot Number: 488691
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/23/2020
• Distributor Facility Aware Date: 05/19/2020
• Initial Date Received by Manufacturer: 05/19/2020
• Supplement Date Received by Manufacturer: 10/12/2021
• Initial Report FDA Received Date: 06/16/2020
• Supplement Report FDA Received Date: 10/13/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1