MAUDE Adverse Event Report: SYNTHES GMBH 5.0MM CANNULATED VA LOCKING SCREW/70MM; SCREW, FIXATION, BONE

Model Number	02.231.670
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Bone Fracture(s) (1870); Pain (1994)
Type of Reportable Event	Serious Injury
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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H10 additional narrative: d2b.Additional pro-code: jdp, hrs d9: complainant part is not expected to be returned for manufacturer review/investigation.E3: initial reporter is lawyer.H3, h4, h6: 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
On (b)(6) 2021, the patient underwent left total knee arthroplasty with distal replacement.Hardware removal left femur due to left supracondylar/intercondylar femoral fracture nonunion, hardware failure and osteoarthritis left knee.On (b)(6) 2021 the patient underwent left distal femur open reduction and internal fixation with a synthes lateral plate and multiple cerclage cables due to left distal femur comminuted intra-articular fracture and morbid obesity.It was reported that on (b)(6) 2021, the patient had a fall.She was climbing over something like a dog gate, tripped and fell.She initially felt pain in her left knee.She was diagnosed with a left distal femur fracture.This complaint involves (18) devices.This report is for one (1) 5.0mm cannulated va locking screw/70mm this report is for complaint (b)(4).

• Brand Name: 5.0MM CANNULATED VA LOCKING SCREW/70MM
• Common Device Name: SCREW, FIXATION, BONE
• Manufacturer (Section D): SYNTHES GMBH; eimattstrasse 3; oberdorf 4436 ; SZ 4436
• Manufacturer Contact: kate karberg ; 1302 wright lane east; west chester, PA 19380 ; 3035526892
• MDR Report Key: 16940211
• Report Number: 8030965-2023-06209
• Device Sequence Number: 7375087
• Product Code: HWC
• UDI-Device Identifier: 10886982062895
• UDI-Public: (01)10886982062895
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K110354
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Device Explanted Year: 2021
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other
• Initial Reporter Occupation: Other
• Type of Report: Initial

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 Model Number: 02.231.670
• Device Catalogue Number: 02.231.670
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 03/22/2023
• Initial Report FDA Received Date: 05/16/2023
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 71 YR
• Patient Sex: Female