MAUDE Adverse Event Report: STRYKER GMBH RC LAG SCREW GAMMA4 Ø10.5X100MM; ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES

Catalog Number	81660100S
Medical Device Problem Code	Positioning Problem (3009)
Health Effect - Clinical Codes	Insufficient Information (4580); No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/19/2024
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Upon completion of the investigation, additional information will be provided in a supplemental report.
Event or Problem Description
As reported: "after lag screw inserted, compression applied, set screw tightened and slightly loosen, when u-blade was inserted with a hammer gently, the femoral head was pushed and the fracture separated.".
Event or Problem Description
As reported: "after lag screw inserted, compression applied, set screw tightened and slightly loosen, when u-blade was inserted with a hammer gently, the femoral head was pushed and the fracture separated.".
Additional Manufacturer Narrative
A review of the device history for the reported lot did not indicate any abnormalities.No corrective actions are required at this time.A review of the labeling did not indicate any abnormalities.No indications of material, manufacturing or design related problems were found during the investigation.After lag screw inserted, compression applied, set screw tightened and slightly loosen, when u-blade was inserted, the femoral head was pushed and the fracture separated.The surgery was finished with pulling the femoral head back somewhat.More detailed information about the complaint event, e.G.X-ray in m-l- view, must be available in order to determine the root cause of the complaint event.At the end of the surgery, it is the responsibility of the surgeon if he leaves the patient as is.Based on investigation, the root cause was attributed to a user related issue.With available information a product deficiency was not verified.In case we receive further substantial information we reserve the right re-open the case and to re-assess the root cause.

• Brand Name: RC LAG SCREW GAMMA4 Ø10.5X100MM
• Common Device Name: ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES
• Manufacturer (Section D): STRYKER GMBH; bohnackerweg 1; postfach; selzach 2545 ; SZ 2545
• Manufacturer (Section G): STRYKER TRAUMA KIEL; prof. kuentscher-strasse 1-5; schoenkirchen/kiel D-242 32; GM D-24232
• Manufacturer Contact: anna jusinski ; 325 corporate drive; mahwah, NJ 07430 ; 2018315000
• MDR Report Key: 19741600
• Report Number: 0009610622-2024-00709
• Device Sequence Number: 3654108
• Product Code: HSB
• UDI-Device Identifier: 07613327591897
• UDI-Public: (01)07613327591897(17)340331(10)K1AD5E2
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K230512
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 10/24/2024

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: Health Professional
• Device Catalogue Number: 81660100S
• Device Lot Number: K1AD5E2
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 06/19/2024
• Supplement Date Received by Manufacturer: 09/24/2024
• Initial Report FDA Received Date: 07/15/2024
• Supplement Report FDA Received Date: 10/24/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 04/04/2024
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 75 YR
• Patient Sex: Male