MAUDE Adverse Event Report: SMITH & NEPHEW, INC. SCR BIORCI-HA 7X30 7MM HEAD STERILE; SCREW, FIXATION, BONE

Model Number	7207677
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/13/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Internal complaint reference: (b)(4).
Event or Problem Description
It was reported that during an arthroscopy, the biorci implant got broken while deployment, implant was removed from the patient.The procedure was completed with a s+n back up device.There was a non-significant surgical delay and no further complications were reported.
Additional Manufacturer Narrative
H10: internal complaint reference: (b)(4).
Event or Problem Description
It was reported that during an arthroscopy, the biorci implant got broken while deployment, implant was removed from the patient.The broken pieces were retrieved from the patient with a grasper arthroscopy instrument.The procedure was completed with a s+n back up device.There was a non-significant surgical delay and no further complications were reported.The back up was used in the same bone hole, there was no void left in the patient.Tunnel size was 6.The insertion site was cleared of all debris and the surgeon was ultimately satisfied with the surgical outcome.
Event or Problem Description
It was reported that during an arthroscopy, the biorci implant broke while deployment.The broken pieces were retrieved from the patient with a grasper arthroscopy instrument.The procedure was completed without significant surgical delay with a s+n back up device used in the same bone hole, there was no void left in the patient.No further complications were reported.Tunnel size was 6.The insertion site was cleared of all debris and the surgeon was ultimately satisfied with the surgical outcome.
Additional Manufacturer Narrative
H3, h6: the reported device was not returned to the designated complaint unit for independent evaluation, thus visual inspection and functional testing could not be performed.A review of device records showed there were no indications to suggest that the product did not meet manufacturing specifications upon release for distribution a complaint history review found similar reported events.The instructions for use were reviewed and found to include conditions of off label use and technique specifics, as well as precautions and warnings related to the use of the device.A risk management review found that the reported failure was documented appropriately, and there were no indications to suggest the anticipated risk is not adequate.A review of the pla/ha blend injection moldable polymer, found that found that the storage requirements for the material are specified, and the material must comply with provided percentage composition specifications as measured by ash test.A clinical review states based on a review of the information provided, a thorough medical investigation cannot be rendered, nor could the definitive root cause of the reported failure be determined.According to the report, the surgeon cleared the insertion site of all debris and completed the procedure with a s&n back-up device with a non-significant delay in the same bone hole.The impact to the patient beyond that which has already reported cannot be determined.Since there was no harm alleged to this patient and it was reported the surgeon was ultimately satisfied with the surgical outcome, no further clinical/medical assessment is warranted at this time.There was no relationship found between the device and the reported event.The complaint was not confirmed.Please refer to the instructions for use for recommendations on proper use of the device and potential troubleshooting methods to prevent future reoccurrence of the reported event.No containment or corrective actions are recommended at this time.If the product associated with this event is returned at a future date, this investigation will be reopened for evaluation.

• Brand Name: SCR BIORCI-HA 7X30 7MM HEAD STERILE
• Common Device Name: SCREW, FIXATION, BONE
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 130 forbes blvd.; mansfield MA 02048
• Manufacturer (Section G): SMITH & NEPHEW, INC.; 130 forbes blvd.; mansfield MA 02048
• Manufacturer Contact: holly topping ; 7000 west william cannon drive; austin, TX 78735 ; 5123913905
• MDR Report Key: 15352689
• Report Number: 1219602-2022-01295
• Device Sequence Number: 20346190
• Product Code: HWC
• UDI-Device Identifier: 03596010459923
• UDI-Public: 03596010459923
• Combination Product (Y/N): N
• Initial Reporter Country: IN
• PMA/510(K) Number: K002274
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 10/05/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 11/05/2025
• Device Model Number: 7207677
• Device Catalogue Number: 7207677
• Device Lot Number: 50904596
• 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: 08/13/2022
• Supplement Date Received by Manufacturer: 09/09/2022; 10/03/2022
• Initial Report FDA Received Date: 09/02/2022
• Supplement Report FDA Received Date: 09/15/2022; 10/05/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/05/2020
• 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
• Outcome Attributed to Adverse Event: Other; Required Intervention
• Patient Sex: Unknown