MAUDE Adverse Event Report: ENCORE MEDICAL L.P. DISCOVERY ELBOW; DISC HUM 4X100MM LT FLANGED C

Model Number 540-34-100

Device Problems Fracture (1260); Appropriate Term/Code Not Available (3191)

Patient Problem Unspecified Infection (1930)

Event Date 07/30/2021

Event Type  Injury  

Manufacturer Narrative

Additional reporting on this event will be provided as a supplemental report to this document as soon as it becomes available.

Event Description

Revision surgery - patient had discovery total elbow in.Had periprosthetic distal humerus fracture and possible infection.Took out discovery humeral component and used zimmer biomet srs humeral replacement, linked to discovery ulna.

Manufacturer Narrative

The reason for this revision surgery was reported as periprosthetic distal humerus fracture and possible infection.The previous surgery and the surgery detailed in this event occurred 1.3 years apart.The healthcare professional indicated there was no delay in surgery and another suitable device was available for use.The revision surgery was completed as intended.The devices were disposed of at hospital and not made available to djo surgical for examination.A review of the device history records (dhr) show that the reported components used in the previous surgery, when released for use, met design and manufacturing requirements.There were no non-conforming material reports (ncmr) associated with the products that may have contributed to the reported event.The devices were verified to have gone through an acceptable sterilization process and were within its expiration date at the time of the previous surgery.Customer complaint history of the reported devices showed no present trends or on-going issues that are needing a review.The root cause of this complaint was a revision surgery due to periprosthetic distal humerus fracture and possible infection.There were no findings during this evaluation that indicate the reported device was the source of the fracture or had a direct connection with the patient's infection.No information was submitted with the complaint regarding pre-existing conditions of the patient or any activities the patient was involved in that may have caused the fracture or contributed to the possible infection or inhibited the patient's immune system.There are multiple factors that may also contribute to an infection that are outside the control of djo surgical.There are no indications of a product or process issue affecting implant safety or effectiveness.Additional reporting on this event will be provided as a supplemental report to this document if it becomes available.

• Brand Name: DISCOVERY ELBOW
• Type of Device: DISC HUM 4X100MM LT FLANGED C
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd; austin TX 78758 5445
• MDR Report Key: 12301392
• MDR Text Key: 265970291
• Report Number: 1644408-2021-00825
• Device Sequence Number: 1
• Product Code: JDC
• UDI-Device Identifier: 00190446137702
• UDI-Public: (01)00190446137702
• Combination Product (y/n): N
• PMA/PMN Number: K013042
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 08/19/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/10/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 540-34-100
• Device Catalogue Number: 540-34-100
• Device Lot Number: 74057
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 08/10/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: 540-00-000 LOT 80317; 540-53-075 LOT 820W1006
• Patient Outcome(s): Required Intervention
• Patient Age: 65 YR