MAUDE Adverse Event Report: SYNTHES TRAUMA : PROSIDYAN, INC. AERIDYAN(TM)MATRIX/SM/3.0CC/STER; FILLER, BONE VOID, CALCIUM COMPOUND

Catalog Number	73000030
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Bone Fracture(s) (1870)
Date of Event	01/01/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
This complaint is from a data use agreement (dua).Data report was from (b)(6) at houston which includes potential complaints related to fibergraft putty and matrix.Attached are the files from fibergraft putty and matrix database.A total of 1 complication that have been reported across 10 patients.Case # 5, 76-year old male.Patient experienced a fracture and fracture dislocation post-operatively requiring revision.Implant(s) involved: part number 73000030 fibergraft matrix unknown plate (1) unknown cortical screw (1).Unknown locking screw (7).
Additional Manufacturer Narrative
Product complaint # (b)(4 ).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.H11 additional manufacturer narrative: d4: udi: as the lot number for the device involved in the event was not provided, the full udi is currently not available.
Additional Manufacturer Narrative
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.H11 additional narrative: h3, h6: product was not returned.Based on the information available, it has been determined that no corrective and 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.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

• Brand Name: AERIDYAN(TM)MATRIX/SM/3.0CC/STER
• Common Device Name: FILLER, BONE VOID, CALCIUM COMPOUND
• Manufacturer (Section D): SYNTHES TRAUMA : PROSIDYAN, INC.; 41 spring st, suite 107; new providence NJ
• Manufacturer Contact: tamala wampler ; 41 spring st, suite 107; new providence, NJ ; 9316443460
• MDR Report Key: 23593847
• Report Number: 3011015097-2025-00006
• Device Sequence Number: 21313448
• Product Code: MQV
• UDI-Device Identifier: 00856879006908
• UDI-Public: (01)00856879006908
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K213803
• 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

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?: No
• Operator of Device: Health Professional
• Device Catalogue Number: 73000030
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 10/31/2025
• Supplement Date Received by Manufacturer: 12/12/2025
• Initial Report FDA Received Date: 11/19/2025
• Supplement Report FDA Received Date: 12/15/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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: 76 YR
• Patient Sex: Male
• Patient Race: White