MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 1.6MM COMPRESSION WIRE 15MM THREAD/150MM LENGTH; INSTRUMENT, COMPRESSION

Model Number	03.211.415
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
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 an unknown date, an unknown surgery procedure was performed.During the procedure, four (4) hexagonal screwdriver shafts were stripped, one (1) elite impression implant kit was broken, one (1) compression wire was broken, and three (3) non-threaded guidewire were broken.There was a surgical delay of five (5) minutes.The procedure outcome is unknown.There is no further information available.This report is for one (1) 1.6mm compression wire 15mm thread/150mm length.This is report 7 of 9 for (b)(4).

• Brand Name: 1.6MM COMPRESSION WIRE 15MM THREAD/150MM LENGTH
• Common Device Name: INSTRUMENT, COMPRESSION
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 11320045
• Report Number: 2939274-2021-00822
• Device Sequence Number: 14488024
• Product Code: HWN
• UDI-Device Identifier: 10886982076304
• UDI-Public: 10886982076304
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• 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): 01/24/2021

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: 03.211.415
• Device Catalogue Number: 03.211.415
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 01/24/2021
• Initial Report FDA Received Date: 02/12/2021
• 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: 1.6MM NON-THREADED GUIDE WIRE- SPADE POINT; CANN SCRWDRVR HANDLE WITH RATCHET QUICK COUPLING; CANNULATED 2.5MM HEXAGONAL SCREWDRIVER SHAFT; CANNULATED 3.5MM HEXAGONAL SCREWDRIVER SHAFT; ELITE COMPRESSION IMPLANT KIT 18X18X18MM 2 LEGS