MAUDE Adverse Event Report: SMITH & NEPHEW, INC. SCR BIORCI-HA 10X25 STERILE; SCREW, FIXATION, BONE

Model Number	7209016
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/30/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Internal complaint reference: (b)(4).
Event or Problem Description
It was reported that during a acl reconstruction procedure, the scr biorci-ha 10x25 sterile broke during deployment into the tibia.The procedure was completed using a back-up device.A delay of less than 30 minutes was reported.No patient complications were reported.
Additional Manufacturer Narrative
Internal complaint reference: (b)(4).H3, h6; the reported device, used in treatment, was not returned to the designated complaint unit for independent evaluation, thus visual inspection and functional testing could not be performed.There was a relationship found between the subject device and the reported incident.A review if the customer provided image shows a used screw with a broken tip.A review of device records showed there were no indications to suggest that the product did not meet manufacturing specification upon release for distribution.A complaint history review concluded this was an isolated event.The instructions for use was reviewed and found to include conditions of off label use and technique specifics, as well as precautions and warnings related to the use of the device.A review of risk management files found that the reported failure was documented appropriately.The complaint was confirmed.Factors that could have contributed to the reported event include an impact event inconsistent with normal use.No containment or corrective actions are recommended at this time.
Event or Problem Description
It was reported that during a acl reconstruction procedure, the scr biorci-ha 10x25 sterile broke during deployment into the tibia.The pieces were removed with tweezers.No additional hole was required.The procedure was completed using a back-up device.A delay of less than 30 minutes was reported.No patient complications were reported.

• Brand Name: SCR BIORCI-HA 10X25 STERILE
• Common Device Name: SCREW, FIXATION, BONE
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 130 forbes blvd.; mansfield MA 02048
• MDR Report Key: 11859190
• Report Number: 1219602-2021-01185
• Device Sequence Number: 14588939
• Product Code: HWC
• UDI-Device Identifier: 03596010460035
• UDI-Public: 03596010460035
• Combination Product (Y/N): N
• Initial Reporter Country: PK
• PMA/510(K) Number: K992396
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 09/08/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 09/25/2024
• Device Model Number: 7209016
• Device Catalogue Number: 7209016
• Device Lot Number: 50830199
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 05/01/2021
• Supplement Date Received by Manufacturer: 06/23/2021; 08/22/2021
• Initial Report FDA Received Date: 05/20/2021
• Supplement Report FDA Received Date: 06/24/2021; 09/08/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1