MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC STAR/HEXDRIVE SCREWDRIVER T25 3.5MM HEX/SELF-RETAINING; SCREWDRIVERS

Model Number	03.010.150
Medical Device Problem Code	Material Twisted/Bent (2981)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Reporter is a j&j employee.The device was received, the investigation is in progress, 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 (b)(6) 2021, (2) star/hex drive screwdriver, (1) driving cap/threaded, (1) long scalpel handle, (1) cannulated hexagonal screwdriver, and (1) hexagonal screwdriver were damaged products.It is unknown if there were patient and procedure involvement.There is no further information available.This report is for (1) star/hexdrive screwdriver t25 3.5mm hex/self-retaining.This is report 1 of 6 for (b)(4).
Additional Manufacturer Narrative
Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.H3, h6: part: 03.010.150, synthes lot: n/a, supplier lot: 5770316, release to warehouse date: april 30, 2008, manufactured by: brandywine, no nonconformance reports (ncrs) generated during production.Review of the device history record(s) showed that there were no issues during the manufacture of this product, and any sub-components, which would contribute to this complaint condition.Visual inspection: the sd/hd scrdriver t25 3.5 hex/self-retain was returned and received at us customer quality (cq).Upon visual inspection, it was observed that the tip of the device was stripped and worn.Due to the worn condition of the tip, device functionality was compromised.The noted issues were consistent as end-of-life indicators for the device.No other issues were identified with the returned device.Conclusion: after a visual inspection per guidance, it is determined that the reusable instrument is worn from repeated use and servicing; therefore, further investigation for the reported complaint device is not required.During the investigation, no product design or manufacturing issues were observed that may have contributed to the complaint condition; therefore, further corrective and/or preventive action is not required.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post market safety surveillance activities.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.

• Brand Name: STAR/HEXDRIVE SCREWDRIVER T25 3.5MM HEX/SELF-RETAINING
• Common Device Name: SCREWDRIVERS
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 12203716
• Report Number: 2939274-2021-04182
• Device Sequence Number: 4371237
• Product Code: HXX
• UDI-Device Identifier: 10886982067975
• UDI-Public: 10886982067975
• Combination Product (Y/N): N
• 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
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/22/2021

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: 03.010.150
• Device Catalogue Number: 03.010.150
• Device Lot Number: 5770316
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/15/2021
• Initial Date Received by Manufacturer: 06/22/2021
• Supplement Date Received by Manufacturer: 07/22/2021
• Initial Report FDA Received Date: 07/21/2021
• Supplement Report FDA Received Date: 08/13/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: CANNULATED 3.5MM HEX SCRWDRV; CANNULATED 4.0MM HEXAGONAL SCREWDRIVER; DRIVING CAP/THREADED; HANDLE FOR TORQUE LIMITING ATTACHMENT; HANDLE WITH QUICK COUPLING, SMALL; LONG SCALPEL HANDLE; SD/HD SCRDRIVER T25 3.5 HEX/SELF-RETAIN; UNIVERSAL CHUCK WITH T-HANDLE