MAUDE Adverse Event Report: SYNTHES GMBH 2.4/2.7MM VA-LCP BENDING PLIER; PLIERS,SURGICAL

Catalog Number	03.211.005
Medical Device Problem Codes	Break (1069); Crack (1135); Device-Device Incompatibility (2919)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the devices were unable to sterilize/assemble.It was also reported that the devices had chipping/cracking and unable to be use.It was unknown if there was patient involvement.This report is for one (1) 2.4/2.7mm va-lcp bending plier this is report 3 of 3 for complaint (b)(4).
Additional Manufacturer Narrative
Product complaint (b)(4).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: d9: complainant part is not expected to be returned for manufacturer review/investigation.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.

• Brand Name: 2.4/2.7MM VA-LCP BENDING PLIER
• Common Device Name: PLIERS,SURGICAL
• 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: 19234953
• Report Number: 8030965-2024-05734
• Device Sequence Number: 6732997
• Product Code: HTC
• UDI-Device Identifier: 10886982076038
• UDI-Public: (01)10886982076038
• Combination Product (Y/N): N
• Initial Reporter State: ND
• 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: Other Health Care Professional
• 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: 03.211.005
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 04/09/2024
• Initial Report FDA Received Date: 05/02/2024
• 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: 2.4/2.7MM VA-LCP BENDING PLIER; 2.7 SCR BLOCK F/SCR MOD SHELL F/MOD GC; 2.7 SCR BLOCK F/SCR MOD SHELL F/MOD GC; G-CASE F/FEM NECK SYST; LID FOR MOD SHELL FOR MOD GRAPHIC CASE; LID FOR MOD SHELL FOR MOD GRAPHIC CASE; MESH PLATE CUTTERS; SCR MODULE SHELL FOR MOD GRAPHIC CASE
• Patient Sex: Unknown