MAUDE Adverse Event Report: SYNTHES GMBH 1.3MM CORTEX SCREW SLF-TPNG WITH T4 STARDRIVE RECESS 10MM; SCREW, FIXATION, BONE

Catalog Number	02.130.010
Medical Device Problem Codes	Break (1069); Entrapment of Device (1212)
Health Effect - Clinical Codes	Foreign Body In Patient (2687); No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/12/2024
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.D2: additional procode: hrs.D9: complainant part is not expected to be returned for manufacturer review/investigation.D10: date of concomitant therapy is (b)(6) 2024.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 (b)(6) 2024, two 1.3mm cortex screw head broke off while inserting into the plate.The shafts of the screws in question remained in the patient, the broken screws were not recoverable.Due to the 2 screw heads breaking off, the surgeon decided to remove the plate along with the other screws that were fully intact and use a tension band instead.There was a surgical delay of 20 minutes due to the removal of the plate and screws and using a different technique to complete the procedure.The procedure was completed successfully with no adverse patient consequences.No further information is available.This report is for a 1.3mm cortex screw slf-tpng with t4 stardrive recess 10mm.This is report 2 of 2 for (b)(4).

• Brand Name: 1.3MM CORTEX SCREW SLF-TPNG WITH T4 STARDRIVE RECESS 10MM
• Common Device Name: SCREW, FIXATION, 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: 18991652
• Report Number: 8030965-2024-04192
• Device Sequence Number: 7591387
• Product Code: HWC
• UDI-Device Identifier: 10886982044167
• UDI-Public: (01)10886982044167
• Combination Product (Y/N): N
• Initial Reporter State: WA
• Initial Reporter Country: US
• PMA/510(K) Number: K150099
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• 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: 02.130.010
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 03/13/2024
• Initial Report FDA Received Date: 03/28/2024
• 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: 1.0 DRILL BIT/STRYKER J-LATCH THRD H/61; 1.0 DRILL BIT/STRYKER J-LATCH THRD H/61; 1.3 CORTEX SCREW SLF-TPNG T4 SD REC 8; 1.3 CORTEX SCREW SLF-TPNG T4 SD REC 8; 1.3 CORTEX SCREW SLF-TPNG T4 SD REC 8; 1.3MM LOCKING STRAIGHT PLATE 12 HOLES
• Patient Sex: Unknown