MAUDE Adverse Event Report: RTI SURGICAL PROVISIONAL TENSIONING DEVICE; ORTHOPEDIC MANUAL SURGICAL INSTRUMENT

Catalog Number	391.884
Medical Device Problem Code	Mechanical Problem (1384)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	08/28/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Complainant part is expected to be returned for manufacturer review/investigation, but has yet to be received.Reporter is company representative.The investigation could not be completed; no conclusion could be drawn, as no product was received.Based on the information available, it has been determined that no corrective and/or preventative action is proposed.This complaint will be accounted for and monitored via post market surveillance activities.If additional information is made available, the investigation will be updated as applicable.Device was used for treatment, not diagnosis.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
Device report from synthes reports an event in (b)(6) as follows: it was reported during a demonstration of the cable system on (b)(6) 2020, the 1.7 mm cable lock, and 2 pieces of tension holder cannot hold the cable properly.No patient or procedure involvement.Concomitant device reported: unknown 1.7mm cable (part #: unknown, lot #: unknown, quantity unknown).This is report 3 of 3 for (b)(4).
Additional Manufacturer Narrative
Product complaint #: (b)(4).Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.H10 additional narrative: d10: device returned 9/10/2020.Investigation summary: background: during a demonstration of the cable system in qeh, the 1.7 cable lock, and 2 pcs of tension holder cannot hold the 1.7 cable properly concomitant device reported: unknown 1.7mm cable (part # unknown, lot # unknown, quantity unknown).This complaint involves three (3) devices.Note: the complaint device was evaluated and investigated at the supplier, rti (pioneer surgical).Investigation flow: device interaction/functional.Visual inspection: the tension holder f/temp-use (part #: 391.884, lot #: p313918) was inspected by rti.Upon visual inspection, the the cam lever surface was found to be galled.Functional test: during functional inspection the cam lever was found to be difficult to lock onto 1.7mm cable.Once lubricated the cam lever was able to lock and the rear bit passed functional testing per wi-eng-006 with a tensioning reading of 42.0k and one cable fray.Compliant could not be replicated after the device was lubricated.Dimensional inspection: no dimensional inspection was performed because the complaint was not able to replicate as the device passed functional testing.Document/specification review: following documents were reviewed; 391_884.Drw rev d (current) and rev c (manufactured) were reviewed.A dhr review was conducted by the supplier and it revealed that the device met manufacturing specification prior to shipping.No design issues or discrepancies were identified.Complaint was confirmed.Investigation conclusion: the complaint condition was confirmed for the tension holder f/temp-use (part #: 391.884, lot #: p313918) as the device was visually inspected and found to have its cam lever surface galled (deep scratches).Also the cam lever on the device was found difficult to lock the 1.7mm cable until lubricated.The as received condition could potentially contribute to the reported condition.No root cause could definitively be determined for the reported complaint condition but it is likely the device experienced extreme mechanical stress and some poor maintenance issues.No new, unique or different patient harms were identified as a result of this evaluation.There was no indication that a design or manufacturing issue contributed to the complaint.No design issues were observed during the document/specification review.Based on the investigation findings, it has been determined that no corrective and/or preventive action is proposed.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post market safety surveillance activities.H3, h4, h6: device history lot: part number:391.884; synthes lot number: p313918; supplier lot number: n/a; release to warehouse date: 11jul2018; expiration date: n/a; supplier: (b)(4).No ncrs were generated during production.Device history batch null, device history review review of the device history record(s) showed that there were no issues during the manufacture of this product, and any sub-components, which would contribute to this complaint condition.Device was used for treatment, not diagnosis.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

• Brand Name: PROVISIONAL TENSIONING DEVICE
• Common Device Name: ORTHOPEDIC MANUAL SURGICAL INSTRUMENT
• Manufacturer (Section D): RTI SURGICAL; 375 river park circle; marquette MI 49855
• MDR Report Key: 10566903
• Report Number: 1833824-2020-00073
• Device Sequence Number: 19500877
• Product Code: LXH
• UDI-Device Identifier: 07611819719859
• UDI-Public: (01)07611819719859
• Combination Product (Y/N): N
• Initial Reporter Country: HK
• PMA/510(K) Number: EXEMPT
• 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
• Report Date (Section B): 08/28/2020

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 Catalogue Number: 391.884
• Device Lot Number: P313918
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 08/27/2020
• Supplement Date Received by Manufacturer: 10/12/2020
• Initial Report FDA Received Date: 09/22/2020
• Supplement Report FDA Received Date: 10/27/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: UNK - CABLE/WIRE.; UNK - CABLE/WIRE