MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US PFC*SIGMA DI AUG16MMCO,SZ3LEFT; SIGMA REVISION IMPLANT : KNEE FEMORAL ACCESSORY

Model Number	96-0871
Medical Device Problem Code	Tear, Rip or Hole in Device Packaging (2385)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/15/2021
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that on (b)(6) 2021, during the resterilization and repackaging process, the operator identified multiple parts displayed a visual cosmetic defect on the top surface of the pfc sigma augments.The augments had foam particles transferred from the packaging components.
Additional Manufacturer Narrative
(b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Additional Manufacturer Narrative
Product complaint # (b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes joint reconstruction, or its employees that the report constitutes an admission that the product, depuy synthes joint reconstruction, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
Additional Manufacturer Narrative
Product complaint # (b)(4).Investigation summary examination of the returned sigma augment confirmed inner foam packaging residue/debris was found transferred to the surface of the device.The debris was found in raynham during repacking/resterilization of expired sterile product returned from the field.Additional complaint information monitoring for potential safety signals is conducted through complaint trending as part of post market surveillance.Depuy 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 product investigation found no evidence suspecting an error in the manufacturing or material that would be a contributing factor in the reported allegation(s).Where the product and lot code was provided, a manufacturing records evaluation (mre) was not performed.

• Common Device Name: SIGMA REVISION IMPLANT : KNEE FEMORAL ACCESSORY
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• Manufacturer (Section G): DEPUY ORTHOPAEDICS 1818910; 700 orthopaedic dr; warsaw IN 46581 0988
• Manufacturer Contact: kara ditty-bovard ; 700 orthopaedic dr.; warsaw, IN 46581-0988 ; 6107428552
• MDR Report Key: 13256650
• Report Number: 1818910-2022-00806
• Device Sequence Number: 4726363
• Product Code: JWH
• UDI-Device Identifier: 10603295234340
• UDI-Public: 10603295234340
• Combination Product (Y/N): N
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 01/13/2022

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: 96-0871
• Device Catalogue Number: 960871
• Device Lot Number: E1CAN4
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/15/2021
• Supplement Date Received by Manufacturer: 01/04/2022; 05/23/2022
• Initial Report FDA Received Date: 01/13/2022
• Supplement Report FDA Received Date: 01/24/2022; 05/25/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 07/16/2010
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT; PFC*SIGMA DI AUG16MMCO,SZ3LEFT
• Patient Sex: Unknown