MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC TFNA FENESTRATED SCREW 95MM - STERILE; ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES

Model Number 04.038.195S

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

Patient Problem Malunion of Bone (4529)

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 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) 2021 the patient underwent a removal due to the malreduction of the original surgery.The original surgery was done at the end of (b)(6) 2020.The trochanteric fixation nail advanced (tfna) femoral nail, femoral neck screws, perforated and 5.0mm ti locking screw were removed successfully.The surgery was completed successfully with no patient consequences.This report is for one (1) tfna fenestrated screw 95mm - 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.A1: patient identifier: (b)(6).Part number: 04.038m195sp, lot number: 50p1647, part manufacture date: march 30, 2020, manufacturing location: elmira, dhr record review: a review of the device history record revealed, no complaint related anomalies.The device history record shows this lot of tfna fenestrated screw 95mm, sterile product was processed through the normal manufacturing.And inspection operations with no rework nor nonconformities noted.This lot was shipped to monument and assigned as part number 04.038.195s for final packaging.This lot met all dimensional, visual and packaging criteria at the time of release with no issues documented, during the manufacture that would contribute to this complaint condition.A review of the raw material device history record revealed, this lot met all specifications with no nonconformance noted.This raw material lot met all dimensional and visual criteria at the time of manufacture with no issues documented, during the manufacture that would contribute to this complaint condition.This lot met all dimensional, visual and packaging criteria at the time of release with no issues documented, during the manufacture that would contribute to this complaint condition.Product was not returned.Based on the information available, it has been determined, that no corrective and 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.

• Brand Name: TFNA FENESTRATED SCREW 95MM - STERILE
• Type of Device: ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 11275109
• MDR Text Key: 230219978
• Report Number: 2939274-2021-00667
• Device Sequence Number: 1
• Product Code: HSB
• UDI-Device Identifier: 10886982098757
• UDI-Public: 10886982098757
• Combination Product (y/n): N
• PMA/PMN Number: K160167
• 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: 01/15/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/03/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 04.038.195S
• Device Catalogue Number: 04.038.195S
• Device Lot Number: 50P1647
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 03/04/2021
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention