MAUDE Adverse Event Report: TREACE MEDICAL CONCEPTS, INC. 2.2MM OLIVE WIRE WITH DRILL TIP

Model Number	1405-2266
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	Foreign Body In Patient (2687)
Date of Event	12/16/2022
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
It was reported that the tip of an olive wire (with drill tip) broke off and was retained in the patient's bone during a bunion procedure on (b)(6) 2022.The case was completed successfully with no additional patient outcomes.Additional information indicates the surgical team determined that the pin collet was not seating properly, which caused the olive wire to spin unevenly, repeatedly contacting the drill guide resulting in its breakage.The udi referenced is for the sterile kit, sk23, the product is distributed within.The device history records for all possible lots were reviewed and no issues were identified during the manufacture and release of the devices that could have contributed to what was reported.The product is manufactured with implant grade material and no adverse events have previously been reported as a result of this failure to date.Based on the available information, the most likely cause of what was reported is that the olive wire broke due to impact with another device.The case was successfully completed with no additional patient outcomes.Although the company has determined that the subject event in this mdr is unlikely to result in a serious injury if it recurred, the company has decided to file the mdr in an abundance of caution and to ensure full compliance with 21 cfr part 803.The company will supplement this mdr as necessary and appropriate.
Event or Problem Description
It was reported that the tip of an olive wire (with drill tip) broke off and was retained in the patient's bone during a bunion procedure on (b)(6) 2022.The case was completed successfully with no additional patient outcomes.

• Brand Name: 2.2MM OLIVE WIRE WITH DRILL TIP
• Common Device Name: OLIVE WIRE
• Manufacturer (Section D): TREACE MEDICAL CONCEPTS, INC.; 100 palmetto park place; ponte vedra FL 32081
• Manufacturer (Section G): TREACE MEDICAL CONCEPTS, INC.; 100 palmetto park place; ponte vedra FL 32081
• Manufacturer Contact: uriza shums ; 100 palmetto park place; ponte vedra, FL 32081 ; 9043735940
• MDR Report Key: 16172309
• Report Number: 3011623994-2023-00002
• Device Sequence Number: 14096008
• Product Code: HWE
• UDI-Device Identifier: 00853114006167
• UDI-Public: 00853114006167
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: N/A-CLASS I
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2022
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 01/15/2023

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: 02/07/2023
• Device Model Number: 1405-2266
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/16/2022
• Initial Report FDA Received Date: 01/15/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 02/07/2020
• 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
• Patient Age: 57 YR
• Patient Sex: Male