MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 10MM TI LATERAL ENTRY FEMORAL RECON NAIL-EX/400MM/RT-STERILE; ROD,FIXATION,INTRAMEDULLARY

Model Number 04.003.360S

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Unspecified Tissue Injury (4559)

Event Type  Injury  

Manufacturer Narrative

Complainant part is not expected to be returned for manufacturer review/ investigation.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 history lot: manufacturing location: (b)(4), manufacturing date: jul 28, 2009, expiration date: jun- 1, 018, part number: 04.003.360s, 10mm ti lateral entry femoral recon nail-ex/400mm/rt-sterile, lot number: 6182035 (non-sterile).Work order traveler met all inspection acceptance criteria.Inspection sheet, in-process acceptance, (b)(4) met all inspection acceptance criteria.Inspection sheet, inspect dimensional, (b)(4) met all inspection acceptance criteria.Inspection sheet, final inspection, (b)(4) met all inspection acceptance criteria.Packaging label log lppf, lmd/lpf rev d was reviewed and determined to be conforming.Packaging bom was reviewed and determined to be conforming with no deviations to normal packaging identified.(b)(4) supplied by (b)(4) was reviewed and determined to be conforming.This lot met all dimensional, visual, sterility and packaging criteria at the time of release with no issues documented during the manufacture that would contribute to this complaint condition.Component part(s) reviewed: component parts were not reviewed as the reported complaint condition of ¿removal for an unknown reason¿ does not indicate breakage of the nail.Therefore, review of the raw materials would not be pertinent to the reported complaint condition.Device history review: this lot met all dimensional, visual, sterility and packaging criteria at the time of release with no issues documented during the manufacture that 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.

Event Description

It was reported that on (b)(6) 2020, the patient underwent a hardware removal of titanium cannulated lateral entry femoral recon nail, titanium end cap and unknown locking screw due to unknown reason.The procedure was successfully completed.This report is for one (1) 10mm ti lateral entry femoral recon nail-ex/400mm/rt-sterile.This is report 2 of 3 for (b)(4).

Manufacturer Narrative

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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H10 additional narrative: 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: 10MM TI LATERAL ENTRY FEMORAL RECON NAIL-EX/400MM/RT-STERILE
• Type of Device: ROD,FIXATION,INTRAMEDULLARY
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 11214627
• MDR Text Key: 228189955
• Report Number: 2939274-2021-00407
• Device Sequence Number: 1
• Product Code: HSB
• UDI-Device Identifier: 10886982082077
• UDI-Public: 10886982082077
• Combination Product (y/n): N
• PMA/PMN Number: K040336
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Type of Report: Initial,Followup
• Report Date: 12/28/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/22/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 06/01/2018
• Device Model Number: 04.003.360S
• Device Catalogue Number: 04.003.360S
• Device Lot Number: 6182035
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 01/25/2021
• Patient Sequence Number: 1
• Treatment: TI END CAP T40 STARDRIVE 0MM EXT FOR FEMORAL NAILS; UNK - SCREWS: LOCKING; TI END CAP T40 STARDRIVE 0MM EXT FOR FEMORAL NAILS; UNK - SCREWS: LOCKING
• Patient Outcome(s): Required Intervention