MAUDE Adverse Event Report: SMITH & NEPHEW, INC. SC HM ST 5-6 10MM LTMD RTLA; PROSTH, KNEE, PATELLOFEMOROTIBIAL, SEMI-CONST, CEMENTED, POLY/METAL/POLY

Model Number	71423035
Medical Device Problem Codes	Inadequacy of Device Shape and/or Size (1583); Device Markings/Labelling Problem (2911)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/21/2021
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that, during surgery, the sc hm st 5-6 10mm ltmd rtla was not the same as the description and the labeling on the box said, the device has the wrong sizing.The procedure was completed, with a delay grater than 30 min, using a s+n back-up device.The condition of the patient is unknown.
Additional Manufacturer Narrative
Section b5 was updated according to the clarification received.Internal complaint reference number: (b)(4).
Event or Problem Description
It was reported that, during surgery, the sc hm st 5-6 10mm ltmd rtla was not the same as the description and the labeling due to its wrong sizing.The procedure was completed, with a delay greater than 30 minutes, using a s+n back-up device.The condition of the patient is unknown.
Additional Manufacturer Narrative
Results of investigation: the associated device was returned and evaluated.A visual inspection of the returned device did not confirm the stated failure mode.The device did not show any signs of mislabeling or labeling error.The dimensional evaluation confirmed the failure mode.The part was found to be out of tolerance for overall length and width for 71423035 (size 5-6), but all measurements are in tolerance for 71423036 (size 7-8).A review of complaint history for the part number over the past 12 months and for the batch number based on historical data of the device did not reveal similar events for the listed device.A review of the manufacturing records did not reveal a manufacturing abnormality that could have caused or contributed to the reported incident.At this time, we do have reason to suspect that the product failed to meet any product specifications at the time of manufacture.A review of the risk management file revealed this failure mode was previously identified.The anticipated risk level is still adequate.Assessment of historical escalated cases concluded that there are no prior actions related to this device and failure mode.A contribution of the device to the reported event could be corroborated as the device was found to be the wrong size.A potential probable cause could included but is not limited to a manufacturing process error.Based on this investigation, the need for corrective action is not indicated.This event evaluated through our internal quality process and was determined to be isolated.Should additional information be received, the complaint will be reopened.No further investigation is warranted for this complaint; however, we will continue to monitor future complaints and investigate as necessary.We consider this investigation closed.

• Brand Name: SC HM ST 5-6 10MM LTMD RTLA
• Common Device Name: PROSTH, KNEE, PATELLOFEMOROTIBIAL, SEMI-CONST, CEMENTED, POLY/METAL/POLY
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• Manufacturer (Section G): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• Manufacturer Contact: holly topping ; 7000 west william cannon drive; austin, TX 78735 ; 5123913905
• MDR Report Key: 11918389
• Report Number: 1020279-2021-04923
• Device Sequence Number: 19627876
• Product Code: JWH
• UDI-Device Identifier: 03596010506344
• UDI-Public: 03596010506344
• Combination Product (Y/N): N
• Initial Reporter Country: IT
• PMA/510(K) Number: K953274
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,User Facility,Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 04/20/2022

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 Expiration Date: 06/22/2022
• Device Model Number: 71423035
• Device Catalogue Number: 71423035
• Device Lot Number: 12FM14268
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/21/2021
• Supplement Date Received by Manufacturer: 04/11/2022; 04/19/2022
• Initial Report FDA Received Date: 06/02/2021
• Supplement Report FDA Received Date: 04/12/2022; 04/20/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 06/22/2012
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown