MAUDE Adverse Event Report: SYNTHES GMBH TIBIAL NAIL-ADVANCED / 9MM 330MM / STERILE; NAIL, FIXATION, BONE

Model Number	04.043.130S
Medical Device Problem Code	Material Twisted/Bent (2981)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional 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.Additional procode: hwc.Complainant part is not expected to be returned for manufacturer review/investigation.Initial reporter is a synthes employee.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 or Problem Description
It was reported that on an unknown date, the tibial nail advanced was used during intra op.Back slap was cross threaded into hammer guide due to off axis and mallet was unable to be taken off.Threaded portion of connecting elements were stripped.Multiple wire guide was bent with wire.Benders were used to bend back guide but did not work.Torque limiters intra op did not work with a qc stryker drill.No surgical delay was reported.No additional information was reported.This report is for a tibial nail-advanced / 9mm 330mm / sterile.This is report 3 of 6 for (b)(4).

• Brand Name: TIBIAL NAIL-ADVANCED / 9MM 330MM / STERILE
• Common Device Name: NAIL, FIXATION, BONE
• Manufacturer (Section D): SYNTHES GMBH; eimattstrasse 3; oberdorf 4436 ; SZ 4436
• Manufacturer (Section G): WERK BETTLACH; muracherstrasse 3; bettlach 2544 ; SZ 2544
• Manufacturer Contact: kate karberg ; 1302 wright lane east; west chester, PA ; 3035526892
• MDR Report Key: 15833886
• Report Number: 8030965-2022-10069
• Device Sequence Number: 6096699
• Product Code: JDS
• UDI-Device Identifier: 10886982297624
• UDI-Public: (01)10886982297624
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K201336
• 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

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: 04.043.130S
• Device Catalogue Number: 04.043.130S
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 10/31/2022
• Initial Report FDA Received Date: 11/21/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: BENDING PLIERS-SMOOTH JAWS FOR MINI PLS; HAMMER GUIDE; NAIL ASSEMBLY INSTRUMENT; RETENTION PIN FOR SCRDRIVER SHORT / XL25; SPIRAL BLD INSERTER FOR RETRO FEM NL-EX; SPIRAL COMBINATION HAMMER 500 GRAMS; TORQUE LIMITER 0.8NM W/AO/ASIF-QC; TORQUE LIMITER 1.5NM F/AO/ASIF; UNK - GUIDE/COMPRESSION/K-WIRES
• Patient Sex: Unknown