MAUDE Adverse Event Report: SMITH & NEPHEW, INC. SCR BIORCI 7X30MM (8MM HEAD) STRL BX 1; FASTENER, FIXATION, BIODEGRADABLE, SOFT TISSUE

Model Number	7207558
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	03/22/2018
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that screw broke while fixed in the femoral tunnel.A backup device was available to complete the procedure with no major delay or patient injuries.
Additional Manufacturer Narrative
Examination was not possible, as the device was not returned.The investigation could not draw any conclusions about the reported event without the return of the device.
Event or Problem Description
It was reported that screw broke while fixed in the femoral tunnel, all pieces were removed from the patient.A backup device was available to complete the procedure with no major delay or patient injuries.

• Brand Name: SCR BIORCI 7X30MM (8MM HEAD) STRL BX 1
• Common Device Name: FASTENER, FIXATION, BIODEGRADABLE, SOFT TISSUE
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 130 forbes boulevard; mansfield MA 02048
• MDR Report Key: 7465889
• Report Number: 1219602-2018-00499
• Device Sequence Number: 16546123
• Product Code: MAI
• UDI-Device Identifier: 03596010426215
• UDI-Public: (01)03596010426215(17)190430(10)50506911
• Combination Product (Y/N): N
• PMA/510(K) Number: K992396
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: distributor,foreign,other,use
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 05/30/2018

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 Expiration Date: 04/30/2019
• Device Model Number: 7207558
• Device Catalogue Number: 7207558
• Device Lot Number: 50506911
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 04/15/2018
• Supplement Date Received by Manufacturer: 05/29/2018
• Initial Report FDA Received Date: 04/26/2018
• Supplement Report FDA Received Date: 05/30/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1