MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC LCP PROXFEM HOOKPL 4.5/5 SHAFT 12HO L313; PLATE, FIXATION, BONE

Catalog Number 242.125S

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Unspecified Infection (1930)

Event Type  Injury  

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.Complainant part is not expected to be returned for manufacturer review/investigation.Reporter is a j&j sales representative.Without a lot number the device history records review could not be completed.Product was not returned.Based on the information available, it has been determined that no corrective and/or preventative action is proposed.This complaint will be accounted for and monitored via post market surveillance activities.If additional information is made available, the investigation will be updated as applicable.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 (b)(6) 2019, patient was revised due to infection.Concomitant device reported: altrx neut 36idx58od(122136058/j2653a).Apex hole elim (124603000/d18101698).Pinn cup 58mm (121722058/j21n76).Bone screw 6.5mmx45mm (121745500/d18051131).This report is for one (1)lcp proxfem hookpl 4.5/5 shaft 12ho l313.This is report 4 of 20 for complaint: (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: g4 product was not returned.Based on the information available, it has been determined that no corrective and preventative action is proposed.This complaint will be accounted for and monitored via post market surveillance activities.If additional information is made available, the investigation will be updated as applicable.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.E1, e2, e4, g2.

• Brand Name: LCP PROXFEM HOOKPL 4.5/5 SHAFT 12HO L313
• Type of Device: PLATE, FIXATION, BONE
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• Manufacturer (Section G): MONUMENT; 1101 synthes avenue; monument CO
• Manufacturer Contact: kate karberg ; 1302 wright lane east; west chester, PA 19380 ; 3035526892
• MDR Report Key: 15675234
• MDR Text Key: 302446045
• Report Number: 2939274-2022-03425
• Device Sequence Number: 1
• Product Code: HRS
• UDI-Device Identifier: 07611819910539
• UDI-Public: (01)07611819910539
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K032032
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Consumer,Health Professional
• 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: 10/26/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Catalogue Number: 242.125S
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 10/12/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Treatment: ALTRX NEUT 36IDX58OD; APEX HOLE ELIM POSITIVE STOP; CANN-LOCKSCR Ø7.3 L35 SST; CERCL-CABLE W/CRIMP Ø1 SST; CERCL-CABLE W/CRIMP Ø1 SST; CERCL-CABLE W/CRIMP Ø1 SST; CERCL-CABLE W/CRIMP Ø1.7 SST; CERCL-CABLE W/CRIMP Ø1.7 SST; CERCL-CABLE W/CRIMP Ø1.7 SST; CERCL-CABLE W/CRIMP Ø1.7 SST; CERCL-CABLE W/CRIMP Ø1.7 SST; CERCL-CABLE W/CRIMP Ø1.7 SST; LCP PROXFEM HOOKPL 4.5/5 SHAFT 8HO L241; LOCKSCR Ø5 SELF-TAP L40 SST; PINN CAN BONE SCREW 6.5MMX45MM; PINNACLE SECTOR II CUP 58MM; POSITION-PIN 4.5 F/LCP SST; POSITION-PIN 4.5 F/LCP SST; POSITION-PIN 4.5 F/LCP SST; POSITION-PIN 4.5 F/LCP SST; POSITION-PIN 4.5 F/LCP SST; POSITION-PIN 4.5 F/LCP SST; POSITION-PIN 4.5 F/LCP SST
• Patient Outcome(s): Required Intervention
• Patient Sex: Male