MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 4.5MM BROAD LCP PLATE 10 HOLES/188MM; PLATE,FIXATION,BONE

Model Number	226.601
Medical Device Problem Code	Material Twisted/Bent (2981)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/29/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Additional procode: hwc, ktt.Complainant part is not expected to be returned for manufacturer review/investigation.Reporter is a j&j employee.Without a lot number the device history records review could not be completed.Product was not returned.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
It was reported that on (b)(6) 2020, 3 plates were stripped, and locking screws did not lock into the plates.The plates in question were 4.5mm broad lcp® plate 9 holes/170mm, 4.5mm broad lcp® plate 10 holes/188mm, and 4.5mm broad lcp® plate 11 holes/206mm.The procedure was completed using another set of implants.There was a surgical delay of 5 minutes.The procedure outcome was unknown.There was no patient consequence.Concomitant devices reported: unknown locking screws (part# unknown, lot# unknown, quantity# unknown).This report is for 1 4.5mm broad lcp® plate 10 holes/188mm.This is report 2 of 3 for (b)(4).

• Brand Name: 4.5MM BROAD LCP PLATE 10 HOLES/188MM
• Common Device Name: PLATE,FIXATION,BONE
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 11072273
• Report Number: 2939274-2020-05703
• Device Sequence Number: 14280475
• Product Code: HRS
• UDI-Device Identifier: 10886982159113
• UDI-Public: (01)10886982159113
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• PMA/510(K) Number: K082807
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 11/29/2020

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: 226.601
• Device Catalogue Number: 226.601
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 11/29/2020
• Initial Report FDA Received Date: 12/24/2020
• Patient Sequence Number: 1