MAUDE Adverse Event Report: ZIMMER BIOMET, INC. GENTLE THREAD 9X30MM FULL THRD; FASTENER, FIXATION

Model Number	N/A
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Adhesion(s) (1695); Scar Tissue (2060)
Date of Event	01/03/2011
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported patient underwent an anterior fibrosis resection three months post implantation due to cyclops syndrome.No additional patient consequences were reported.Attempts to obtain additional information have been made; however, no more is available.
Additional Manufacturer Narrative
(b)(4).Concomitant medical products: cat: 905617 lot: 510340 gentle thread 9x25mm round hd.Report source: foreign- france.Customer has indicated that the product will not be returned to zimmer biomet for investigation, as the device remains implanted.The investigation is in process.Once the investigation has been completed, a follow-up mdr will be submitted.Multiple mdr reports were filed for this event, please see associated reports: 0001825034 - 2023 - 00065.
Event or Problem Description
No additional event information is available at the time of this report.
Additional Manufacturer Narrative
This follow-up report is being submitted to relay additional information.The following sections were updated: b4, b5, d4, g3, g6, h1, h2, h3, h4, h6, h10 cyclop syndrome is caused by a scar tissue nodule adjacent to the tibial tunnel of the anterior cruciate ligament graft after surgery.As the scar tissue builds around the graft and zimmer biomet's implants were directly correlated with the screws, there are no allegations against the device and all implants remain in place.Hence, the reported device did not cause or contribute to the reported event.The initial report was forwarded in error and should be voided.

• Brand Name: GENTLE THREAD 9X30MM FULL THRD
• Common Device Name: FASTENER, FIXATION
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; p.o. box 587; warsaw IN 46581
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 56 e. bell drive; p.o. box 587; warsaw IN 46581
• Manufacturer Contact: jennifer rapsavage ; 56 e. bell dr.; warsaw, IN 46582 ; 5745260384
• MDR Report Key: 16138334
• Report Number: 0001825034-2023-00064
• Device Sequence Number: 12443156
• Product Code: HWC
• UDI-Device Identifier: 00880304006676
• UDI-Public: (01)00880304006676
• Combination Product (Y/N): N
• Initial Reporter Country: FR
• PMA/510(K) Number: K041274
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2010
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Study,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 01/27/2023

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?: No
• Operator of Device: Health Professional
• Device Expiration Date: 05/31/2015
• Device Model Number: N/A
• Device Catalogue Number: 905608
• Device Lot Number: 490880
• Was Device Available for Evaluation?: No
• 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: 08/17/2022
• Supplement Date Received by Manufacturer: 01/23/2023
• Initial Report FDA Received Date: 01/11/2023
• Supplement Report FDA Received Date: 01/27/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 03/31/2010
• 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: Required Intervention
• Patient Age: 45 YR
• Patient Sex: Unknown