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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 5.0MM FLEXIBLE SHAFT; REAMER

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WRIGHTS LANE SYNTHES USA PRODUCTS LLC 5.0MM FLEXIBLE SHAFT; REAMER Back to Search Results
Catalog Number 352.040
Device Problem Device-Device Incompatibility (2919)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 07/14/2021
Event Type  malfunction  
Manufacturer Narrative
(b)(4).Complainant part is not expected to be returned for manufacturer review/investigation.Occupation: reporter is a j&j 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 Description
Device report from synthes reports an event in (b)(6) as follows: it was reported that on (b)(4) 2021, the patient underwent for a procedure.During the procedure, the flexible reaming rod was not self-retaining the reaming tips.There was no fragment generated.The procedure was completed successfully.The patient outcome was unknown.Concomitant device reported: unknown reduction head (part#: unknown, lot#: unknown, quantity: 1).This complaint involves two (2) devices.This report is for (1) 5.0mm flexible shaft.This report is 1 of 1 for (b)(4).
 
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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H10 additional narrative: d7a.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.
 
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Brand Name
5.0MM FLEXIBLE SHAFT
Type of Device
REAMER
Manufacturer (Section D)
WRIGHTS LANE SYNTHES USA PRODUCTS LLC
1302 wrights lane east
west chester PA 19380
MDR Report Key12318560
MDR Text Key266401834
Report Number2939274-2021-04650
Device Sequence Number1
Product Code HTO
UDI-Device Identifier07611819243668
UDI-Public(01)07611819243668
Combination Product (y/n)N
PMA/PMN Number
EXEMPT
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Type of Report Initial,Followup
Report Date 07/15/2021
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
Device Operator Health Professional
Device Catalogue Number352.040
Was Device Available for Evaluation? No
Initial Date Manufacturer Received 07/15/2021
Initial Date FDA Received08/13/2021
Supplement Dates Manufacturer Received09/16/2021
Supplement Dates FDA Received09/16/2021
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
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