MAUDE Adverse Event Report: ZIMMER GMBH ANN BLUNT TIP SCREW 4X38MM; TRAUMA, INSTRUMENTS

Model Number	N/A
Medical Device Problem Code	Migration (4003)
Health Effect - Clinical Codes	Failure of Implant (1924); Pain (1994)
Date of Event	05/28/2024
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).D4: product id was provided for four screws however, it is unknown which of the three screws has migrated.Therefore, the migrated screw could be any of the following: 47248603840 - ann blunt tip screw 4x38mm - 3185170 udi: (b)(4).Manufacturing date: nov 28, 2023, expiration date: (b)(6) 2028.47248604040 - ann blunt tip screw 4x40mm - 3181917 udi: (b)(4).Manufacturing date: nov 3, 2023, expiration date: (b)(6) 2028.47248604240 - ann blunt tip screw 4x42mm- 3181919 udi: (b)(4).Manufacturing date: nov 10, 2023, expiration date: (b)(6) 2028.D10: 47-2496-221-08 proximal humerus, left, long, ã¿ 8.5x220mm 3177532, 47-2486-040-40 ann blunt tip screw 4x40mm 3181917, 47-2486-042-40 ann blunt tip screw 4x42mm 3181919, 47-2486-128-40 ann cort bone screw 4 x 28mm 3191519, 47-2486-130-40 ann cort bone screw 4 x 30mm 3177549, 47-2488-010-00 affixus ph nl cap 0mm 3189257.G2: report source japan.The device will not be returned for analysis; however, an investigation of the reported event is in progress.Once the investigation is completed, a supplemental medwatch 3500a will be submitted.
Event or Problem Description
It was reported patient underwent revision approximately 4 weeks from the initial surgery, surgeon found one of the proximal screws was backed out from the proper position.The patient complained of pain and a revision was performed to remove the migrated screw.Attempts have been made and additional information on the reported event is unavailable at this time.
Additional Manufacturer Narrative
(b)(4).This follow-up report is being submitted to relay additional information.No product was returned or pictures provided; visual and dimensional evaluations could not be performed.A review of the device manufacturing records confirmed no abnormalities or deviations.Review of complaint histories identified additional similar complaints for the reported products and additional similar complaints for the reported part and lot combinations.Based on the available information, the reported event cannot be confirmed.It can be assumed that multiple contributing factors, related to either patient condition and behavior or implantation procedure, contributed to the migration of the screws.If and to what extent any of these aspects may have influenced the migration of the screw remains unknown.An additional deeper investigation was performed which identified the design limitation of the corelock mechanism of the affixus nail as a potential contributing factor.As part of the deeper investigation, a scientific literature search was conducted and a systematic review of the outcome of intramedullary nailing for acute proximal humerus fracture showed that screw migration and perforation into the joint is the second most common complication following secondary loss of reduction.In addition, scientific literature of competitor and predicate devices were assessed.This review has shown that the affixus® natural nail® proximal humeral system performs better and/or in equal range in comparison with legally marketed similar devices.In conclusion, as the cause may be multifactorial an exact root cause could not be identified for the migration of the screw.If any further information is found which would change or alter any conclusions or information, a supplemental will be filed accordingly.Zimmer biomet will continue to monitor for trends.
Event or Problem Description
No further event information available at the time of this report.

• Brand Name: ANN BLUNT TIP SCREW 4X38MM
• Common Device Name: TRAUMA, INSTRUMENTS
• Manufacturer (Section D): ZIMMER GMBH; sulzer allee 8; sulzer industrie park; winterthur 8404 ; SZ 8404
• Manufacturer (Section G): ZIMMER GMBH; sulzer allee 8; sulzer industrie park; winterthur 8404 ; SZ 8404
• Manufacturer Contact: christina arnt ; 56 e. bell dr.; warsaw, IN 46582 ; 5745273773
• MDR Report Key: 19579275
• Report Number: 0009613350-2024-00247
• Device Sequence Number: 8493152
• Product Code: HSB
• UDI-Device Identifier: 00889024505438
• UDI-Public: (01)00889024505438(17)281128(10)3185170
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K200814
• 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
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 08/09/2024

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?: Yes
• Operator of Device: Lay User/Patient
• Device Model Number: N/A
• Device Catalogue Number: 47248603840
• Device Lot Number: 3185170
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/29/2024
• Supplement Date Received by Manufacturer: 07/31/2024
• Initial Report FDA Received Date: 06/20/2024
• Supplement Report FDA Received Date: 08/09/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 11/28/2023
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SEE H11.
• Outcome Attributed to Adverse Event: Required Intervention; Hospitalization
• Patient Sex: Unknown