MAUDE Adverse Event Report: SMITH & NEPHEW, INC. GII SPC P/S CAM MODULE SZ 5; PRSTHSSKNEEPATLL/FEMOROTIBIAL,SMI-CNSTRND,UNCMNTD,POROUS,COATED,PLYMR/MTL/PLYMR

Model Number 71433365

Device Problem Break (1069)

Patient Problem No Patient Involvement (2645)

Event Date 08/06/2020

Event Type  malfunction  

Event Description

It was reported that the hinge attachment on the gii spc p/s cam module sz 5 was found broken off.No case involved.

Manufacturer Narrative

H6: the device, intended for use in treatment, was not returned for evaluation.Therefore, product analysis could not be performed at this time.So the reported event could not be confirmed.A complaint history review found related failures; this failure mode will be monitored for future complaints for any necessary corrective actions.A review of the manufacturing records did not reveal any manufacturing or material abnormalities that could have caused or contributed to the reported incident this device is a reusable instrument that can be exposed to numerous surgeries; damage from repeated use can occur.Damage from prolonged use, misuse or rough handling are likely probable causes 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.Without the actual product involved and/or device information, our investigation cannot proceed.If the device or new information is received in the future, this complaint can be re-opened.No further investigation warranted for these complaints; however, we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.

• Brand Name: GII SPC P/S CAM MODULE SZ 5
• Type of Device: PRSTHSSKNEEPATLL/FEMOROTIBIAL,SMI-CNSTRND,UNCMNTD,POROUS,COATED,PLYMR/MTL/PLYMR
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• MDR Report Key: 10492138
• MDR Text Key: 205621654
• Report Number: 1020279-2020-04385
• Device Sequence Number: 1
• Product Code: MBH
• UDI-Device Identifier: 00885556031612
• UDI-Public: 00885556031612
• Combination Product (y/n): N
• PMA/PMN Number: K121393
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 04/24/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/03/2020
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 71433365
• Device Catalogue Number: 71433365
• Device Lot Number: 12AM03189A
• Date Manufacturer Received: 08/06/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1