MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US TRUMATCH CT CUT GUIDE KIT L; TRUMATCH INSTRUMENTS : RESECTION BLOCKS/DEVICES

Model Number	420915
Medical Device Problem Codes	Incorrect Measurement (1383); Patient-Device Incompatibility (2682)
Health Effect - Clinical Codes	Unspecified Tissue Injury (4559); No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/23/2022
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 after cutting tibia the slope was 14 degrees instead of the planned 3 degrees.Patient¿s natural tibia slope on the plan was 17 degrees.Surgeon did not use recommended 1.19mm whale tail.
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.H10 additional narrative: added: b5, e1 (initial reporter facility name) and h6 (impact code).If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.Corrected: b3.
Event or Problem Description
Additional information was stating that the surgical delay would have been 10-15 minutes requiring the recuts.
Additional Manufacturer Narrative
Product complaint # (b)(4).Investigation summary : the device associated with the reported event was not returned for evaluation.The investigation could not confirm the reported event.Segmentation is designed within trumatch specifications and no issues were identified.Depuy considers the investigation closed.Should additional info be received, the investigation will be re-opened as necessary.Device history lot : dhr reviewed, no deviations or nonconformance's were noted.Device history review : dhr reviewed, no deviations or nonconformance's were noted.

• Brand Name: TRUMATCH CT CUT GUIDE KIT L
• Common Device Name: TRUMATCH INSTRUMENTS : RESECTION BLOCKS/DEVICES
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• Manufacturer (Section G): DEPUY RAYNHAM, A DIV. OF DEPUY ORTHO 1219655; 325 paramount drive; raynham MA 02767
• Manufacturer Contact: kara ditty-bovard ; 700 orthopaedic dr.; warsaw, IN 46581-0988 ; 6107428552
• MDR Report Key: 13732918
• Report Number: 1818910-2022-04513
• Device Sequence Number: 14460345
• Product Code: NJL
• UDI-Device Identifier: 10603295384854
• UDI-Public: 10603295384854
• 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,Followup
• Report Date (Section B): 03/11/2022

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 Expiration Date: 07/31/2022
• Device Model Number: 420915
• Device Catalogue Number: 420915
• Device Lot Number: 00040885
• 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: 02/25/2022
• Supplement Date Received by Manufacturer: 03/23/2022; 03/24/2022; 04/20/2022
• Initial Report FDA Received Date: 03/11/2022
• Supplement Report FDA Received Date: 03/24/2022; 03/30/2022; 04/21/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 01/27/2022
• 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