MAUDE Adverse Event Report: SYNTHES GMBH INTERLCKNG BOLT 4.5 VA COND INSERTN HNDL; CONDYLAR PLATE FIXATION IMPLANT

Catalog Number	03.231.005
Medical Device Problem Code	Device-Device Incompatibility (2919)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
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: e3: reporter is a j&j employee.D9: complainant part is expected to be returned for manufacturer review/investigation, but has yet to be received.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
It was reported that on an unknown date, during a nail plate combo, va condylar aiming arm was used.The cortical screw missed the plate.There was a delay in surgery due to having to freehand.There was 3 minutes of surgical delay.Procedure outcome was unknown.There was no patient consequences.This report is for one (1) interlckng bolt 4.5 va cond insertn hndl.This is report 3 of 7 for complaint (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.Part# 03.231.005 lot # 7532980 manufacturing site: werk hägendorf.Supplier; na release to warehouse date: 07 sep 2011 expiration date: na a manufacturing record evaluation was performed for the finished article lot and no non-conformances were identified the product was returned to depuy synthes for evaluation.The depuy synthes team conducted a visual inspection of the returned device.Visual analysis of the returned sample revealed that interlckng bolt 4.5 va cond insertn hndl shows normal wear consistent with the device use which would not contribute to the reported alleged condition.A dimensional inspection for the interlckng bolt 4.5 va cond insertn hndl was not performed as it is not applicable to the complaint condition.A functional test was performed with the mating sample device (insertion handle f/aiming arm f/va-lcp c part number: 03.231.001 and mating device aim-arm f/va-lcp condylar pl 4.5/5.0 le part number: 03.231.003) and the devices were able to assemble and disassemble with without any issues.A complete functional testing of the received device was not performed as the mating plate was not returned.The complaint condition was not able to be replicated.As part of depuy synthes quality process, all devices are manufactured, inspected, and released to approved specifications.The overall complaint was not confirmed as the observed condition of the interlckng bolt 4.5 va cond insertn hndl would not contribute to the complained device issue.There is no indication that a design or manufacturing issue has caused the complaint condition and hence the root cause cannot be determined.Based on the investigation findings, it has been determined that no corrective and/or preventative action is proposed.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post-market safety surveillance activities.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: INTERLCKNG BOLT 4.5 VA COND INSERTN HNDL
• Common Device Name: CONDYLAR PLATE FIXATION IMPLANT
• Manufacturer (Section D): SYNTHES GMBH; eimattstrasse 3; oberdorf 4436 ; SZ 4436
• Manufacturer (Section G): MONUMENT; 1101 synthes avenue; monument CO 80132
• Manufacturer Contact: kate karberg ; 1302 wright lane east; west chester, PA 19380 ; 3035526892
• MDR Report Key: 18785276
• Report Number: 8030965-2024-02914
• Device Sequence Number: 8351615
• Product Code: JDP
• UDI-Device Identifier: 10886982077325
• UDI-Public: (01)10886982077325
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• PMA/510(K) Number: K110354
• 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: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 02/26/2024

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: 03.231.005
• Device Lot Number: 7532980
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/12/2024
• Supplement Date Received by Manufacturer: 04/04/2024
• Initial Report FDA Received Date: 02/26/2024
• Supplement Report FDA Received Date: 04/23/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 09/07/2011
• 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: AIM ARM FOR 4.5 VA-LCP CRVD COND PL/LFT; AIM ARM FOR 4.5 VA-LCP CRVD COND PL/LFT; AIM ARM FOR 4.5 VA-LCP CRVD COND PL/RT; AIM ARM FOR 4.5 VA-LCP CRVD COND PL/RT; INTERLCKNG BOLT 4.5 VA COND INSERTN HNDL; UNK - NAILS; UNK - PLATES: TRAUMA; UNK - SCREWS: CORTICAL : TRAUMA
• Patient Sex: Unknown