MAUDE Adverse Event Report: SMITH & NEPHEW, INC. PERI-LOC 4.5MM T25 TI LCK SCR 66MM S-T; PLATE, FIXATION, BONE

Model Number 71867066

Device Problem Connection Problem (2900)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 06/14/2021

Event Type  malfunction  

Event Description

It was reported that, during a trauma surgery while the instrument was inside of the patient, the screw was not locked and penetrated the hole on the plate.The peri-loc 4.5mm ti l-d fem pl 8h l 193mm, peri-loc 4.5mm t25 ti lck scr 66mm s-t, two (2) peri-loc 4.5mm t25 ti lck scr 64mm s-t and peri-loc 4.5mm t25 ti lck scr 58mm s-t; it was unknown if the plate or which screws reported were defective.The procedure was successfully completed putting back and rotating in an opposite direction without delay using the same device.Patient was not harmed.

Manufacturer Narrative

H3, h6: the device, used in treatment, was not returned for evaluation and the reported event could not be confirmed.A review of the manufacturing records did not reveal a manufacturing abnormality that could have caused or contributed to the reported incident.A review of complaint history did not reveal additional complaints for the listed batch.At this time, we have no reason to suspect that the product failed to meet any product specifications at the time of manufacture.Some potential probable causes for this event could include a fit/ sizing issue or poor insertion technique.Based on this investigation, the need for corrective action is not indicated.Without the return of the actual product involved, our investigation could not proceed.Should the device or additional information be received, the complaint will be reopened.No further investigation is warranted for this complaint; however, we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.

• Brand Name: PERI-LOC 4.5MM T25 TI LCK SCR 66MM S-T
• Type of Device: PLATE, FIXATION, BONE
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• MDR Report Key: 12082287
• MDR Text Key: 258872288
• Report Number: 1020279-2021-05483
• Device Sequence Number: 1
• Product Code: HRS
• UDI-Device Identifier: 03596010641694
• UDI-Public: 03596010641694
• Combination Product (y/n): N
• PMA/PMN Number: K083032
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Type of Report: Initial,Followup
• Report Date: 08/06/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 06/29/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 71867066
• Device Catalogue Number: 71867066
• Device Lot Number: 20GT40101
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 08/05/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1