MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 2.7 VA-LCP LATERAL DSTL FIB PL/4 H/RT-S; PLATE, FIXATION, BONE

Model Number	02.118.402S
Medical Device Problem Code	Device-Device Incompatibility (2919)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
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.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 or Problem Description
It was reported that on an unknown date, during an unknown procedure, variable angle (va) distal fibula plate distal locking hole malfunctioned, and the variable angle (va) locking screw did not lock into the plate.A metaphyseal plate was used and there seemed to be a brown rust on the ss.There was a surgical delay of three (3) minutes.Procedure outcome is unknown.No patient consequence.This is report 1 of 2 for (b)(4).

• Brand Name: 2.7 VA-LCP LATERAL DSTL FIB PL/4 H/RT-S
• Common Device Name: PLATE, FIXATION, BONE
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 11649321
• Report Number: 2939274-2021-01799
• Device Sequence Number: 14373285
• Product Code: HRS
• UDI-Device Identifier: 10886982038838
• UDI-Public: (01)10886982038838
• 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): 03/16/2021

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: 02.118.402S
• Device Catalogue Number: 02.118.402S
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 03/16/2021
• Initial Report FDA Received Date: 04/12/2021
• Patient Sequence Number: 1