MAUDE Adverse Event Report: DEPUY IRELAND - 3015516266 QUICKSET ACE GRATER CS COMPL; HIP INSTRUMENTS : INSTRUMENT CASES

Catalog Number	244000501
Medical Device Problem Codes	Peeled/Delaminated (1454); Material Deformation (2976); Naturally Worn (2988)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/21/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Product complaint # (b)(4).Investigation summary: an analysis of the product could not be performed since a physical sample was not received for evaluation.An evaluation of the manufacturing record could not be performed as the required product identification number was not provided to complete the evaluation.As part of our company quality system process, all devices are manufactured, inspected, and distributed to approved specifications.Additional complaint information monitoring for potential safety signals will be conducted through complaint trending as part of the post-market surveillance.However, if the product or product id numbers are received at a later date, the investigation will be updated as applicable.
Event or Problem Description
It was reported that the trays were found old and deteriorating.It did not happen in surgery.
Additional Manufacturer Narrative
Product complaint # (b)(4).D4: udi: as the lot number for the device involved in the event was not provided, the full udi is currently not available.This report is being submitted pursuant to the provisions of 21 cfr, part 803 (and/or part 4, as applicable).This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes, or its employees that the report constitutes an admission that the product, depuy synthes, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
Additional Manufacturer Narrative
Product complaint #(b)(4) investigation summary = > it was reported that the trays found old and deteriorating.It did not happen in surgery.The product was returned to j&j medtech orthopaedics for evaluation.Visual analysis of the returned device revealed that the lid was missing.Signs of wear were observed on the overall surface, consistent with extensive and repeated use over many years.There was no evidence of peeling coating.The device also exhibited surface discoloration, which was identified as an indicator of end of life condition.The lifecycle requirements of the device are event related and depend on the use and inspection of the device in clinical practice.As the device can be damaged on the first or 100th use, the device must be properly inspected prior to each surgical use.Refer to the device/country specific ifu for information related to end of life, reprocessing instructions, and inspection procedures.A functional test was not performed since it was not applicable to the complaint condition.A dimensional inspection was not performed since it was not applicable to the complaint condition.The overall complaint was confirmed as the observed condition of the quickset ace grater cs compl would have contributed to the complained issue.Based on the investigation findings, it has been determined that no corrective and/or preventative action is proposed.There is no indication that a design or manufacturing issue has caused the reported complaint condition.As part of j&j medtech orthopaedics quality process, all devices are manufactured, inspected, and released to approved specifications.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post-market safety surveillance activities.Device history lot = > a manufacturing records evaluation (mre) was not performed as no lot number was able to be retrieved for this device.H11 additional narrative: corrected: h3.
Additional Manufacturer Narrative
Product complaint # (b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes joint reconstruction, or its employees that the report constitutes an admission that the product, depuy synthes joint reconstruction, or its employees caused or contributed to the potential event described in this report.H11 additional narrative: added: d9, d10.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.

• Brand Name: QUICKSET ACE GRATER CS COMPL
• Common Device Name: HIP INSTRUMENTS : INSTRUMENT CASES
• Manufacturer (Section D): DEPUY IRELAND - 3015516266; loughbeg ringaskiddy co.; cork ; EI
• Manufacturer (Section G): JTE WARSAW MFG SITE; 700 orthopaedic drive; warsaw IN 46582
• Manufacturer Contact: kate karberg ; 700 orthopaedic dr.; warsaw, IN 46581-0988 ; 3035526892
• MDR Report Key: 20579903
• Report Number: 1818910-2024-22834
• Device Sequence Number: 20995200
• Product Code: FSM
• UDI-Device Identifier: 10603295123712
• UDI-Public: (01)10603295123712
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• 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,Followup,Followup,Followup
• Report Date (Section B): 10/31/2024

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: 244000501
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 10/29/2024
• Supplement Date Received by Manufacturer: 11/02/2024; 11/04/2024; 11/08/2024
• Initial Report FDA Received Date: 10/31/2024
• Supplement Report FDA Received Date: 11/04/2024; 11/05/2024; 11/11/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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: QUICKSET ACE GRATER CS B TRAY; QUICKSET ACE GRATER CS B TRAY; QUICKSET ACE GRATER CS B TRAY; QUICKSET ACE GRATER CS B TRAY; QUICKSET ACE GRATER CS COMPL; QUICKSET ACE GRATER CS COMPL; QUICKSET ACE GRATER CS COMPL; QUICKSET ACE GRATER CS COMPL; QUICKSET ACE GRATER CS M TRAY; QUICKSET ACE GRATER CS M TRAY; QUICKSET ACE GRATER CS M TRAY; QUICKSET ACE GRATER CS M TRAY; QUICKSET ACE GRATER CS T TRAY; QUICKSET ACE GRATER CS T TRAY; QUICKSET ACE GRATER CS T TRAY; QUICKSET ACE GRATER CS T TRAY
• Patient Sex: Unknown