MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 3.2MM TROCAR; MISC ORTHO SURGICAL INSTR

Model Number	03.010.069
Medical Device Problem Code	Device-Device Incompatibility (2919)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/01/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Product complaint # (b)(4).Additional narrative: complainant part is expected to be returned for manufacturer review/investigation but has yet to be received.Reporter is a j&j sales representative.Without a lot number, the device history records review could not be completed as no product was received.The investigation could not be completed, no product was received; no conclusion could be drawn at the time of filing this report.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, the patient underwent for a surgery.During the surgery, when the surgeon was installing a tibia nail using our suprapatellar tibia nailing system, unable to get the proximal locking screws through the nail using the aiming arm and the devices may be out of alignment.It is unknown if fragments generated.There was no surgical delay.The procedure successfully completed.No patient consequence.Concomitant device reported: unk - screw (part# unknown; lot# unknown; quantity: unknown).Unk - nails (part# unknown; lot# unknown; quantity: unknown).This complaint involves seven (7) devices.This report is for (1) 3.2mm trocar.This report is 3 of 7 for (b)(4).

• Brand Name: 3.2MM TROCAR
• Common Device Name: MISC ORTHO SURGICAL INSTR
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 12004727
• Report Number: 2939274-2021-02981
• Device Sequence Number: 3241998
• Product Code: LXH
• UDI-Device Identifier: 10886982067418
• UDI-Public: (01)10886982067418
• Combination Product (Y/N): N
• Initial Reporter State: IL
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 05/22/2021

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: 03.010.069
• Device Catalogue Number: 03.010.069
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 05/22/2021
• Initial Report FDA Received Date: 06/15/2021
• Patient Sequence Number: 1