MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 3.5 LCP CLAV HK PL 7H 15 HK DPTH/86/LT-S; PLATE, FIXATION, BONE

Model Number 241.105S

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Skin Inflammation/ Irritation (4545)

Event Type  Injury  

Manufacturer Narrative

The investigation could not be completed; no conclusion could be drawn, as no product was received.Without a lot number the device history records review could not be completed.Product was not returned.Based on the information available, it has been determined that no corrective and/or preventative action is proposed.This complaint will be accounted for and monitored via post market surveillance activities.If additional information is made available, the investigation will be updated as applicable.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

It was reported that on an unknown date, the patient underwent a fracture fixation for a lateral fracture utilizing lcp clavicular hook plate 3.5.Union was achieved after 16 weeks.Reoperation was done due to hardware removal; patient could feel implant irritation.Patient outcome is unknown.This report is for one (1) 3.5 lcp clav hk pl 7h 15 hk dpth/86/lt-s.This is report 1 of 1 for (b)(4).

• Brand Name: 3.5 LCP CLAV HK PL 7H 15 HK DPTH/86/LT-S
• Type of Device: PLATE, FIXATION, BONE
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• Manufacturer (Section G): MONUMENT; 1101 synthes avenue; monument CO 80132
• Manufacturer Contact: kara ditty-bovard ; 1302 wrights lane east; west chester, PA 19380 ; 6103142063
• MDR Report Key: 12489552
• MDR Text Key: 271977902
• Report Number: 2939274-2021-05539
• Device Sequence Number: 1
• Product Code: HRS
• UDI-Device Identifier: 10886982165886
• UDI-Public: (01)10886982165886
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K061753
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,study
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 08/23/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/17/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 241.105S
• Device Catalogue Number: 241.105S
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 08/23/2021
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Treatment: UNK - SCREWS: CORTEX
• Patient Outcome(s): Required Intervention
• Patient Age: 47 YR