MAUDE Adverse Event Report: SMITH & NEPHEW, INC. R3 0DEG 28MM TRIAL 58MM; ORTHOPEDIC MANUAL SURGICAL INSTRUMENT

Model Number	71360558
Medical Device Problem Codes	Break (1069); Scratched Material (3020)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/18/2021
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that.A r3 0deg 28mm trial 50mm, r3 0deg 28mm trial 52mm, r3 0deg 28mm trial 54mm, r3 0deg 28mm trial 56mm and a r3 0deg 28mm trial 58mm are scratched and has broken locking tabs.No case involved.
Additional Manufacturer Narrative
H10: internal complaint reference: (b)(4).H3, h6: the device, intended for use in treatment, was returned for evaluation.A visual inspection of the returned r3 0deg 28mm trial 58mm confirms the device has multiple scratches/gouges in the plastic.The locking tabs are also broken, rendering the device inoperable.A complaint history review found related failures; this failure mode will be monitored for future complaints for any necessary corrective actions.A review of the manufacturing records did not reveal a manufacturing abnormality that could have caused or contributed to the reported incident.The device is a reusable instrument that can be exposed to numerous surgeries and cleaning cycles.As plastics are vulnerable and crack may have initiated during use and possible causes could be due to the heating and cooling associated with autoclaving or prolonged use.We recommend that all reusable instruments be routinely inspected for wear and damage and replaced as necessary.At this time, we have no reason to suspect that the product failed to meet any product specifications at the time of manufacture.Based on this investigation, the need for corrective action is not indicated.Should additional information be received, the complaint will be reopened.No further investigation warranted for this complaint; however we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.

• Brand Name: R3 0DEG 28MM TRIAL 58MM
• Common Device Name: ORTHOPEDIC MANUAL SURGICAL INSTRUMENT
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• MDR Report Key: 12425108
• Report Number: 1020279-2021-06737
• Device Sequence Number: 19714791
• Product Code: LXH
• UDI-Device Identifier: 03596010598905
• UDI-Public: 03596010598905
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 10/04/2021

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: 71360558
• Device Catalogue Number: 71360558
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/13/2021
• Initial Date Received by Manufacturer: 08/18/2021
• Supplement Date Received by Manufacturer: 10/01/2021
• Initial Report FDA Received Date: 09/03/2021
• Supplement Report FDA Received Date: 10/04/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1