MAUDE Adverse Event Report: DEPUY SPINE INC PENCIL HANDLE; MISC ORTHO SURGICAL INSTR

Catalog Number	299704145
Medical Device Problem Code	Contamination /Decontamination Problem (2895)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	10/18/2023
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.H10 additional narrative: d9: complainant part is expected to be returned for manufacturer review/investigation but has yet to be received.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 on wednesday, october 18th, sets were dropped off for cases on friday, october 20th.Upon receipt of these sets, there were multiple instruments that were dubbed unfit to be used in surgery (part numbers of each instrument have been included).Spd ran a boroscope down each of the cannulated instruments (which we as reps do not have access to at any of our accounts to check these ourselves), and found multiple instruments that fell outside of their guidelines for safe use in surgery.Subsequently, i had to run to multiple different hospitals around denver to be able to make these sets complete and usable.This put me outside of the guidelines put in place by the va in terms of timeliness on dropping off the trays.Event occurred during sterile processing and field inspection.There were patient outcomes or consequences.One of the two cases scheduled had to be cancelled this report is for one (1)pencil handle.This is report 4 of 10 for complaint (b)(4).

• Brand Name: PENCIL HANDLE
• Common Device Name: MISC ORTHO SURGICAL INSTR
• Manufacturer (Section D): DEPUY SPINE INC; 325 paramount drive; raynham MA 02767
• Manufacturer Contact: kate karberg ; 325 paramount drive; raynham, MA 02767 ; 3035526892
• MDR Report Key: 18096884
• Report Number: 1526439-2023-02258
• Device Sequence Number: 20261013
• Product Code: LXH
• UDI-Device Identifier: 10705034467245
• UDI-Public: (01)10705034467245
• Combination Product (Y/N): N
• Initial Reporter State: CO
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• 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

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: 299704145
• Device Lot Number: GB128401
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 10/24/2023
• Initial Report FDA Received Date: 11/08/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: EXPED VERSE NAV DRIVER - SHAFT; PENCIL HANDLE; T-HANDLE, RATCHETING; TEAR-DROP HANDLE, RATCHETING; TEAR-DROP HANDLE, RATCHETING
• Patient Sex: Unknown