MAUDE Adverse Event Report: SMITH & NEPHEW, INC. 4MM TROCAR DRILL SLEEVE ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES

Model Number 71631026

Device Problem Mechanical Jam (2983)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 11/05/2021

Event Type  malfunction  

Event Description

It was reported that a 4mm trocar drill sleeve is jamming. As this was noticed upon field inspection, there was not patient involvement.

Manufacturer Narrative

Internal reference number: (b)(4).

• Brand Name: 4MM TROCAR DRILL SLEEVE
• Type of Device: ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• Manufacturer (Section G): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• Manufacturer Contact: holly topping ; 7000 west william cannon drive; austin; austin, TX 78735 ; 5123913905
• MDR Report Key: 12865719
• MDR Text Key: 281205671
• Report Number: 1020279-2021-08354
• Device Sequence Number: 1
• Product Code: HSB
• UDI-Device Identifier: 03596010604910
• UDI-Public: 03596010604910
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K122170
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign,Company Representative

Reporter Occupation

• Type of Report: Initial,Followup
• Report Date: 02/16/2022

1 Device was Involved in the Event

0 Patients were Involved in the Event:

• Date FDA Received: 11/23/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes

Device Operator

• Device Model Number: 71631026
• Device Catalogue Number: 71631026
• Device Lot Number: 20JM02046
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 02/15/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 09/02/2020
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unkown