MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US MBT REV PRIMARY CONICAL REAMER; KNEE INSTRUMENT : REAMERS

Model Number 2178-63-199

Device Problem Material Twisted/Bent (2981)

Patient Problem Insufficient Information (4580)

Event Date 05/04/2021

Event Type  malfunction  

Manufacturer Narrative

Product complaint #:(b)(4).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 the two reamer chucks stripped our and the cone reamer is stripped.Needs replaced.Delayed progress of case because it kept stripping.A surgical delay of 10 minutes was noted.

Manufacturer Narrative

Product complaint #
=
> (b)(4) this report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes joint reconstruction, or its employees that the report constitutes an admission that the product, depuy synthes joint reconstruction, or its employees caused or contributed to the potential event described in this report.H10 additional narrative: added: d4 (lot number) and d9 if information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.Corrected h3.

Manufacturer Narrative

Product complaint # (b)(4).Investigation summary =examination of the returned device confirmed the reamer was stripped.The investigation did not indicate that a broader investigation or corrective action was necessary.Depuy considers the investigation closed at this time.Should additional information be received, the information will be reviewed and the investigation will be re-opened as necessary.Device history lot = the product investigation found no evidence suspecting an error in the manufacturing or material that would be a contributing factor in the reported allegation(s).A manufacturing records evaluation (mre) was not performed.

• Brand Name: MBT REV PRIMARY CONICAL REAMER
• Type of Device: KNEE INSTRUMENT : REAMERS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• MDR Report Key: 11833206
• MDR Text Key: 250896055
• Report Number: 1818910-2021-10476
• Device Sequence Number: 1
• Product Code: HTO
• UDI-Device Identifier: 10603295096535
• UDI-Public: 10603295096535
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Type of Report: Initial,Followup,Followup
• Report Date: 05/04/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/17/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 2178-63-199
• Device Catalogue Number: 217863199
• Device Lot Number: PG215182
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/14/2021
• Date Manufacturer Received: 07/01/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1