MAUDE Adverse Event Report: TORNIER INC PERFORM HUMERAL IMPACTOR TIP SIZE 1/2

Catalog Number	MWM051
Medical Device Problem Codes	Crack (1135); Fracture (1260)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/29/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Upon completion of the investigation, additional information will be provided in a supplemental report.
Event or Problem Description
It was reported that the impactor tip was found broken in half.
Event or Problem Description
It was reported that the impactor tip was found broken in half.
Additional Manufacturer Narrative
Corrections: h6 (device & results) codes.The reported event was confirmed since the product was returned for evaluation and matches the alleged failure mode.The device inspection revealed the following visual inspection: the visual inspection of the returned device reveals crack of impactor tip.Few impaction marks are visible on proximal end of tip along with some black spots.Overall failure indicates rough usage.A review of the device history for the reported lot did not indicate any abnormalities.No corrective actions are required at this time.No indications of material or manufacturing related problems were found during the investigation.A review of the labeling did not indicate any abnormalities.Based on investigation the root cause was attributed to combination of design and normal usage related issue.The failure was caused by its intended use.As a device that is manufactured of plastic and incurs numerous impaction events cleaning and sterilization cycles, breakage as noted in this complaint can be expected.If any further information is provided the complaint report will be updated.

• Brand Name: PERFORM HUMERAL IMPACTOR TIP SIZE 1/2
• Common Device Name: IMPACTOR
• Manufacturer (Section D): TORNIER INC; 10801 nesbitt avenue s; bloomington MN 55437
• Manufacturer (Section G): TORNIER INC; 10801 nesbitt avenue s; bloomington MN 55437
• Manufacturer Contact: dannielle stap ; 325 corporate drive; mahwah, NJ 07430 ; 2018315000
• MDR Report Key: 22912575
• Report Number: 0001649390-2025-00601
• Device Sequence Number: 18446934
• Product Code: HWA
• UDI-Device Identifier: 00846832082841
• UDI-Public: (01)00846832082841(11)220105(21)CV0121363
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 12/17/2025

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: MWM051
• Device Lot Number: CV0121
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/05/2025
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 07/30/2025
• Supplement Date Received by Manufacturer: 11/19/2025
• Initial Report FDA Received Date: 08/28/2025
• Supplement Report FDA Received Date: 12/17/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/05/2022
• 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: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown