MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 1.6 WIRE GUIDE FOR 3.7 CANN LCKNG SCREWS; GUIDE, SURGICAL, INSTRUMENT

Model Number	360.266
Medical Device Problem Code	Device-Device Incompatibility (2919)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/22/2021
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that on (b)(6) 2021, during a proximal humerus, the surgeon had difficulties getting the wire guide sleeve for 3.7 cannulated screws to thread into the plate.Ultimately, he switched to using a regular locking to we, a wire sleeve to measure the screw and placed it successfully.Procedure was completed successfully with five(5) minutes surgical delay.No patient consequences.This report is for one (1) 1.6 wire guide for 3.7 cann lckng screws.This is report 3 of 3 for complaint (b)(4).
Additional Manufacturer Narrative
Complainant part is expected to be returned for manufacturer review/investigation but has yet to be 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.
Additional 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.H3, h4, h6: part #: 360.266.Synthes lot #: 6352482.Supplier lot #: n/a.Released to warehouse: september 29, 2010.Manufactured by: (b)(4).No ncrs were generated during production.Review of the device history record(s) showed that there were no issues during the manufacture of this product, and any sub-components, which would contribute to this complaint condition.Visual inspection: the 1.6 wire guide for 3.7 cann lckng screws (part# 360.266, lot# 6352482) was returned and received at us customer quality (cq).Upon visual inspection of the complaint device showed the treaded tip was stripped.No other issues were observed with the complaint device.Functional test: a functional assessment was not able to perform on the complaint device since it was returned without relevant mating device.However, the stripped condition of the threaded tip could have contributed to the device interaction issue.Can the complaint be replicated with the returned device(s)? unable to perform dimensional inspection: feature: small shaft diameter close to treaded tip specification.Measured dimension: conforming.Result: conforming.Measurement device: caliper.Document/specification review: based on the date of manufacture, the current and manufactured revision of drawings were reviewed no design issues or discrepancies were identified.Complaint confirmed? yes.Investigation conclusion: this complaint was confirmed as the device was stripped and could contributed to the complaint condition.No definitive root cause could be determined based on the provided information.There was no indication that a design or manufacturing issue contributed to the complaint.Based on the investigation findings, it has been determined that no corrective and/or preventative action is proposed.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post-market safety surveillance activities.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.

• Brand Name: 1.6 WIRE GUIDE FOR 3.7 CANN LCKNG SCREWS
• Common Device Name: GUIDE, SURGICAL, INSTRUMENT
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• Manufacturer (Section G): ELMIRA; 35 airport road; horseheads NY 14845
• Manufacturer Contact: kara ditty-bovard ; 1302 wright lane east; west chester, PA 19380 ; 6107195000
• MDR Report Key: 13003885
• Report Number: 2939274-2021-07078
• Device Sequence Number: 11940911
• Product Code: FZX
• UDI-Device Identifier: 10886982197603
• UDI-Public: (01)10886982197603
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup

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: 360.266
• Device Catalogue Number: 360.266
• Device Lot Number: 6352482
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/09/2021
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 12/09/2021
• Supplement Date Received by Manufacturer: 12/09/2021
• Initial Report FDA Received Date: 12/14/2021
• Supplement Report FDA Received Date: 12/20/2021
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 09/29/2010
• 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
• Concomitant Medical Products and Therapy/Usage Dates: 1.6 WIRE GUIDE FOR 3.7 CANN LCKNG SCREWS; 3.5 LCP PROXIMAL HUM PL-STD 3H SFT/90
• Patient Age: 76 YR
• Patient Sex: Female