MAUDE Adverse Event Report: SYNTHES GMBH TI MATRIX SAGITTAL SPLIT PLATE STRAIGHT/4 HOLES/10MM BAR; PLATE, BONE

Catalog Number	04.511.423
Medical Device Problem Code	Defective Device (2588)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	02/26/2024
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.H10 additional narrative: d9: complainant part is not expected to be returned for manufacturer review/investigation.E1: initial reporter phone: (b)(6).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
Device report from australia reports an event as follows: it was reported that on (b)(6) 2024 during a revision procedure with 3d printed patient-specific bsso plates, every time the plate was put on, the patient¿s bite went out.The plate didn¿t match the contour.The surgeon discarded the 3d plates and used stock plates from the matrixorthognathic set.The patient ended up with an anterior open bite, so the surgeon brought them in again on (b)(6) 2024 for revision surgery to reposition the plate and add new screws.No further information is available.This report is for a ti matrix sagittal split plate straight/4 holes/10mm bar.This is report 1 of 1 for (b)(4).

• Brand Name: TI MATRIX SAGITTAL SPLIT PLATE STRAIGHT/4 HOLES/10MM BAR
• Common Device Name: PLATE, BONE
• 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: 18896054
• Report Number: 8030965-2024-03585
• Device Sequence Number: 20709197
• Product Code: JEY
• UDI-Device Identifier: 10887587024394
• UDI-Public: (01)10887587024394
• Combination Product (Y/N): N
• Initial Reporter Country: AS
• PMA/510(K) Number: K083388
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Device Explanted Year: 2024
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,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?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Catalogue Number: 04.511.423
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/26/2024
• Initial Report FDA Received Date: 03/13/2024
• 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
• Concomitant Medical Products and Therapy/Usage Dates: MATRIX SCREW Ø1.85 SELF-TAP L5 TAN 1U I/; MATRIX SCREW Ø2.1 SELF-TAP L6 TAN 1U I/C
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown