MAUDE Adverse Event Report: SMITH & NEPHEW, INC. D-RAD VOLAR GUIDE BLOCK 3H/4H LEFT STD; PLATE, FIXATION, BONE

Model Number	71158045
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/17/2021
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that, during an unspecified surgery a piece of the d-rad volar guide block 3h/4h left std broke off outside the patient.The procedure was completed without delay using a smith and nephew back-up device.No other complications were reported.
Additional Manufacturer Narrative
H3, h6: the device, intended for use in treatment was returned for evaluation: a visual inspection was conducted and confirmed that the d-rad volar guide block 3h/4h left std has a missing piece which could cause it to not properly function.The missing piece was not returned with the device.The manufactured date for this device is 2018.A review of complaint history on the listed part revealed no prior complaints for the listed batch with the same failure mode.A review of the manufacturing records did not reveal a manufacturing abnormality that could have caused or contributed to the reported incident.This device is a reusable instrument that can be exposed to numerous surgeries; damage from repeated use can occur.Damage from prolonged use, misuse or rough handling are likely probable causes of the reported event.We recommend that all reusable instruments be routinely inspected for wear and damage and replaced as necessary.At this time, we have no reason to suspect that the product failed to meet any product specifications at the time of manufacture.Based on this investigation, the need for corrective action is not indicated.No further investigation is warranted for this complaint; however, we will continue to monitor for future complaints and investigate as necessary.Should additional information be received, the complaint will be reopened.We consider this investigation closed.

• Brand Name: D-RAD VOLAR GUIDE BLOCK 3H/4H LEFT STD
• Common Device Name: PLATE, FIXATION, BONE
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• MDR Report Key: 11478870
• Report Number: 1020279-2021-02065
• Device Sequence Number: 3276284
• Product Code: HRS
• UDI-Device Identifier: 00885556631287
• UDI-Public: 00885556631287
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: K161665
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 05/10/2021

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: 71158045
• Device Catalogue Number: 71158045
• Device Lot Number: 18DSC0026
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/02/2021
• Initial Date Received by Manufacturer: 02/17/2021
• Supplement Date Received by Manufacturer: 04/13/2021
• Initial Report FDA Received Date: 03/14/2021
• Supplement Report FDA Received Date: 05/10/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1