MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US U OSTEOTOME 10.5MM X 8 IN; HIP INSTRUMENTS : CUTTING INSTRUMENTS

Model Number	2422-31-000
Medical Device Problem Codes	Material Deformation (2976); Naturally Worn (2988)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/24/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Product complaint # (b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Event or Problem Description
It was reported that the osteotomes are bent and the ends have a rough edge.1 opened and 2nd still in packaging.These have not yet been used in surgery.
Additional Manufacturer Narrative
Product complaint # (b)(4).Investigation summary: the device associated with this report was not returned for analysis.After reviewing photographic evidence complaint is confirmed.Depuy-synthes considers the investigation closed at this time.Should additional information be received, the information will be reviewed, and the investigation will be re-opened as necessary.Device history lot: the ri for lot vz156291 shows the following: lot quantity: (b)(4).Ri type: reduced inspection.Inspection date: jun 17, 2021.Po #: (b)(4).Review of the receiving inspection (ri) record in etq for lot # vz156291 found no nonconformance for this lot.Ref.(b)(4).Device history review: the ri for lot vz156291 shows the following: lot quantity:(b)(4).Ri type: reduced inspection.Inspection date: jun 17, 2021.Po #: (b)(4).Review of the receiving inspection (ri) record in etq for lot # vz156291 found no nonconformance for this lot.

• Brand Name: U OSTEOTOME 10.5MM X 8 IN
• Common Device Name: HIP INSTRUMENTS : CUTTING INSTRUMENTS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• Manufacturer (Section G): DEPUY ORTHOPAEDICS, INC. 1818910; 700 orthopaedic dr.; warsaw IN 46581 0988
• Manufacturer Contact: kara ditty-bovard ; 700 orthopaedic dr.; warsaw, IN 46581-0988 ; 6107428552
• MDR Report Key: 12953657
• Report Number: 1818910-2021-27393
• Device Sequence Number: 4216775
• Product Code: LYS
• UDI-Device Identifier: 10603295123170
• UDI-Public: 10603295123170
• Combination Product (Y/N): N
• Initial Reporter Country: UK
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 12/07/2021

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: 2422-31-000
• Device Catalogue Number: 242231000
• Device Lot Number: VZ156291
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/24/2021
• Supplement Date Received by Manufacturer: 02/22/2022
• Initial Report FDA Received Date: 12/07/2021
• Supplement Report FDA Received Date: 02/22/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/07/2021
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Unknown