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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC PLATE CUTTER/IN-LINE FOR 1.3MM LCKNG/1.5-2.0MM VAL PL PLIERS, SURGICAL

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WRIGHTS LANE SYNTHES USA PRODUCTS LLC PLATE CUTTER/IN-LINE FOR 1.3MM LCKNG/1.5-2.0MM VAL PL PLIERS, SURGICAL Back to Search Results
Model Number 03.130.270
Device Problem Break (1069)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 02/01/2021
Event Type  Malfunction  
Manufacturer Narrative

Product complaint #(b)(4). Complainant part is expected to be returned for manufacturer review/investigation, but has yet to be received. Initial reporter is j&j company representative. The investigation could not be completed. No conclusion could be drawn, as no product was received. 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

Device report from synthes (b)(6) reports an event in as follows: it was reported that during the in service, the clamp instrument broke. This complaint is for one (1) plate cutter/in-line for 1. 3mm lckng/1. 5-2. 0mm val pl. This report is 1 of 1 for (b)(4).

 
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Brand NamePLATE CUTTER/IN-LINE FOR 1.3MM LCKNG/1.5-2.0MM VAL PL
Type of DevicePLIERS, SURGICAL
Manufacturer (Section D)
WRIGHTS LANE SYNTHES USA PRODUCTS LLC
1302 wrights lane east
west chester PA 19380
Manufacturer (Section G)
SYNTHES TUTTLINGEN
unter hasslen 5
tuttlingen 78532
SZ 78532
Manufacturer Contact
kara ditty-bovard
1302 wrights lane east
west chester, PA 
6107195000
MDR Report Key11365669
MDR Text Key242478604
Report Number2939274-2021-01004
Device Sequence Number1
Product Code HTC
Combination Product (Y/N)N
Reporter Country CodeCA
PMA/PMN NumberEXEMPT
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type COMPANY REPRESENTATIVE,FOREIG
Reporter Occupation
Type of Report Initial,Followup
Report Date 02/02/2021
1 Device Was Involved in the Event
0 PatientS WERE Involved in the Event:
Date FDA Received02/23/2021
Is This An Adverse Event Report? No
Is This A Product Problem Report? Yes
Device Operator HEALTH PROFESSIONAL
Device MODEL Number03.130.270
Device Catalogue Number03.130.270
Device LOT NumberT126575
Was Device Available For Evaluation? Device Returned To Manufacturer
Date Returned to Manufacturer03/15/2021
Is The Reporter A Health Professional?
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received03/15/2021
Was Device Evaluated By Manufacturer? Yes
Date Device Manufactured01/10/2016
Is The Device Single Use? No
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Unkown

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