MAUDE Adverse Event Report: BIOMET 3I ANGLED SCREW CHANNEL DRIVER TIP 24MM; DENTAL DRIVER

Model Number	ASCDT24
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Zimmer biomet complaint number: (b)(4).Patient identifier: unknown / not provided.Age and date of birth: unknown / not provided.Gender: unknown / not provided.Patient weight: unknown / not provided.Date of event: unknown / not provided.Pma/510(k) number: unknown / not provided.
Event or Problem Description
It was reported that the angled driver broke during torquing.Procedure was completed using another driver.
Event or Problem Description
No further event information available at the time of this report.
Additional Manufacturer Narrative
One (1) angled screw channel driver tip 24mm (ascdt24) was returned for investigation.Visual evaluation of the as returned product identified signs of use.Fracture identified at driver's tip.Functional testing to recreate the reported event could not be performed due to the nature of the device & event.A pre-existing condition noted on the per was unknown bone density type.The reported device was used on an unknown tooth site (universal.) the length of the device usage is unknown.The customer did not provide any pictures or x-rays.Appropriate documentation was performed.Dhr review was completed for the subject lot number (1230390v).It was confirmed that all operations and inspections were executed as per applicable procedure.No deviations or non-conformances, which could have caused or contributed to the reported event, were noted as part of the dhr.Lot was inspected and passed all acceptance criteria by qa.Complaint history review was performed for the reported lot number (1230390v) for similar events and no other complaint was identified.December post market trending was reviewed and there were no actionable events or corrective actions for the reported event (fracture) or product (ascdt24).No actionable items have been triggered that will affect complaint handling on our end for this month.Based on the available information, device malfunction did occur, and the reported event was confirmed.The following sections have been updated: b4: date of this report g3: date received by manufacturer g6: checked "follow-up" h2: checked follow-up type h3: changed "no" to "yes" h6: entered evaluation codes h10: added manufacturer narrative.

• Brand Name: ANGLED SCREW CHANNEL DRIVER TIP 24MM
• Common Device Name: DENTAL DRIVER
• Manufacturer (Section D): BIOMET 3I; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer (Section G): BIOMET 3I; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer Contact: susanne taylor ; 4555 riverside drive; palm beach gardens, FL 33410 ; 5617766700
• MDR Report Key: 15663286
• Report Number: 0001038806-2022-01621
• Device Sequence Number: 5979403
• Product Code: NDP
• UDI-Device Identifier: 00844868044017
• UDI-Public: (01)00844868044017(17)240819(10)1230390V
• Combination Product (Y/N): N
• Initial Reporter State: WA
• 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
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date (Section B): 02/22/2023

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: 08/19/2024
• Device Model Number: ASCDT24
• Device Catalogue Number: ASCDT24
• Device Lot Number: 1230390V
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/29/2022
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/29/2022
• Supplement Date Received by Manufacturer: 02/20/2023
• Initial Report FDA Received Date: 10/24/2022
• Supplement Report FDA Received Date: 02/22/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 08/21/2019
• 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
• Patient Sex: Prefer Not To Disclose