MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US ZT TRIAL SLEEVE 18D LRG; HIP INSTRUMENTS : FEMORAL TRIALS

Catalog Number	257618115
Medical Device Problem Code	Material Deformation (2976)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	04/09/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Event or Problem Description
During surgery, surgeon and surgical techs references that some of the instruments were damaged from use over the years, and difficult to read.They asked that it would be nice to get them replaced.No additional time was added to this case as result to their complaints.No complications occurred due to the instruments.Product will be shipped back once hospital receives replacement please ship replacement to (b)(6).Patient consequence? no.
Additional Manufacturer Narrative
Event or Problem Description
Surgeon used the sleeve as a cutting guide.Saw blade damage made the "18d lrg" eligible on the spout of the trial.
Additional Manufacturer Narrative
Additional Manufacturer Narrative
(b)(4).Examination of the returned instrument confirmed the complaint.Depuy considers the investigation closed at this time.Should additional information be received, the information will be reviewed and the investigation will be re-opened as necessary.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

• Brand Name: ZT TRIAL SLEEVE 18D LRG
• Common Device Name: HIP INSTRUMENTS : FEMORAL TRIALS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46582 0988
• MDR Report Key: 7490076
• Report Number: 1818910-2018-58968
• Device Sequence Number: 16179297
• Product Code: LXH
• UDI-Device Identifier: 10603295146612
• UDI-Public: 10603295146612
• Combination Product (Y/N): N
• Initial Reporter State: VT
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Health Professional
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 04/10/2018

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 Catalogue Number: 257618115
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/14/2018
• Initial Date Received by Manufacturer: 04/10/2018
• Supplement Date Received by Manufacturer: 05/10/2018; 05/18/2018; 06/15/2018
• Initial Report FDA Received Date: 05/07/2018
• Supplement Report FDA Received Date: 05/14/2018; 05/22/2018; 06/20/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1