MAUDE Adverse Event Report: SYNTHES GMBH TIBIAL NAIL-ADVANCED / 12MM 345MM / STERILE; NAIL, FIXATION, BONE

Catalog Number	04.043.435S
Medical Device Problem Code	Device-Device Incompatibility (2919)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/31/2023
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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H10 additional narrative: d2: additional procode: hwc d9: complainant part is not expected to be returned for manufacturer review/investigation.D10: date of concomitant therapy is 31-july-2023.H3, h6: the investigation could not be completed; no conclusion could be drawn, as no product was received.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 (b)(6) 2023, the pin had fallen out of the tna driving cap.During the procedure, a tna nail was inserted, but then removed to dial in the reduction.When the nail was extracted, it was noticed that the poly inserted distally had moved outside of the nail, the surgical tech was not able to put back into the nail, and a new nail was selected.This nail was also extracted for repositioning and the sleeve had moved as well, but surgeon decided to move forward and drill through the poly insert.Additionally, the surgeon was having issues inserting the nail through the suprapatellar protection sleeve, so it was removed and the nail was inserted without the sleeve.During the surgery, the surgeon used a drill bit in a ¿blocking¿ fashion to redirect the nail, but the drill bit was unable to remain stable because of the comminution.Then a blocking screw was used.The surgery was successfully completed with no surgical delay.There was no adverse patient impact.No further information is available.This report is for a tibial nail-advanced / 12mm 345mm / sterile.This is report 2 of 4 for (b)(4).
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.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 history lot part #: 04.043.435s-us lot #: 170p155 manufacturing site: jabil bettlach release to warehouse date: 24, june 2021 expiry date: 31, may 2031 a manufacturing record evaluation was performed for the finished device lot and no non-conformance was identified.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.

• Brand Name: TIBIAL NAIL-ADVANCED / 12MM 345MM / STERILE
• Common Device Name: NAIL, FIXATION, BONE
• Manufacturer (Section D): SYNTHES GMBH; eimattstrasse 3; oberdorf 4436 ; SZ 4436
• Manufacturer (Section G): WERK BETTLACH (CH); muracherstrasse 3; bettlach 2544 ; SZ 2544
• Manufacturer Contact: kate karberg ; 1302 wright lane east; west chester, PA ; 3035526892
• MDR Report Key: 17548591
• Report Number: 8030965-2023-10298
• Device Sequence Number: 20574675
• Product Code: JDS
• UDI-Device Identifier: 10886982298089
• UDI-Public: (01)10886982298089
• Combination Product (Y/N): N
• Initial Reporter State: TX
• 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: Physician
• Type of Report: Initial,Followup

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 Catalogue Number: 04.043.435S
• Device Lot Number: 170P155
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 07/31/2023
• Supplement Date Received by Manufacturer: 08/16/2023
• Initial Report FDA Received Date: 08/15/2023
• Supplement Report FDA Received Date: 08/30/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 06/24/2021
• 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: 14.5 OUTER PROTEC SLV SUPRAPATELLAR -S; 4.2 3-FLTD DRILL BIT QC/NEEDLE PT/145; DRIVING CAP; TIBIAL NAIL-ADVANCED / 12 345 / STERILE; UNK - SCREWS: TRAUMA
• Patient Age: 44 YR
• Patient Sex: Male