MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC DEPTH GAUGE FOR 2.0MM AND 2.4MM SCREWS; GAUGE,DEPTH

Catalog Number 319.006

Device Problem Break (1069)

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

Event Date 12/01/2021

Event Type  malfunction  

Manufacturer Narrative

Product complaint # (b)(4).Event year is reported as 2021; however exact date of event is unknown.Complainant part is expected to be returned for manufacturer review/ investigation but has yet to be received.Reporter is a j&j representative.The investigation could not be completed, no product was received; no conclusion could be drawn at the time of filing this report.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 unknown date, products found broken after surgery and are beyond repair.No further information is available.This complaint involves (18) devices.This report is for (1) depth gauge for 2.0mm and 2.4mm screws.This report is 5 of 14 for (b)(4).

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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H10 additional narrative: the reported condition of the complaint device (depth gauge f/scr ø2+2.4 meas-range up-t) is confirmed.There was no indication that a design or manufacturing issue contributed to the complaint.No design issues were observed during the document/ specification review.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 history lot: part # 319.006; synthes lot # 6146150; supplier lot # n/a; release to warehouse date: 22 may2009; manufactured by: synthes brandywine.No ncrs were generated during production.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: DEPTH GAUGE FOR 2.0MM AND 2.4MM SCREWS
• Type of Device: GAUGE,DEPTH
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• Manufacturer (Section G): BRANDYWINE; 1303 goshen parkway; west chester PA 19380
• Manufacturer Contact: kara ditty-bovard ; 1302 wright lane east; west chester, PA 19380 ; 6107195000
• MDR Report Key: 13196508
• MDR Text Key: 287280218
• Report Number: 2939274-2022-00068
• Device Sequence Number: 1
• Product Code: HTJ
• UDI-Device Identifier: 07611819707238
• UDI-Public: (01)07611819707238
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/07/2022
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: 319.006
• Device Lot Number: 6146150
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/04/2022
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 02/07/2022
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 05/22/2009
• Is the Device Single Use?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Treatment: 5.0MM FLEXIBLE SHAFT; 5.0MM FLEXIBLE SHAFT; 5.0MM FLEXIBLE SHAFT; 5.0MM FLEXIBLE SHAFT 620MM; DPTH GUGE FOR 2.7MM & SML SCRWS; GRPC CASE FOR 3.5/4.0MM CMBND CANULD SCRW SET; GRPHIC CSE FOR 3.5/4.0MM COMBND CANNLTED SCRW SET; HELICAL BLADE/SCREW COUPLING SCREW; HOLD-FORCEPS F/SYNREAM REAMING ROD Ø2.5; HOLDSLEEVE W/WINGSCR L105 I-Ø 6 F/LARGE-; LARGE QUICK COUPLING; RATCHET WRENCH-11MM WIDTH ACROSS FLATS; RATCHTNG HANDL W QUICK CUPLING; SM FRG LCP INST & IMPL SET GRPIC CASE; SOCKET WRENCH-11MM WIDTH ACROSS FLATS; UNIVERSAL CHUCK WITH T-HANDLE; UNIVERSAL CHUCK WITH T-HANDLE