MAUDE Adverse Event Report: SMITH & NEPHEW, INC. GII LONG I/M ROD 16 INCH; PRSTHSIS,KN,PATLL/FMRTIBIAL,SMI-CNSTRND,UNCMNTD,PRS,COAD,OLYMER/METAL/POLYMER

Catalog Number	71440004
Medical Device Problem Code	Blocked Connection (2888)
Health Effect - Clinical Code	No Information (3190)
Date of Event	06/05/2018
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that surgeon placed im rod into the femur firmly and became stuck in the canal with t-handle very firmly and rod wouldn¿t come out used more force rod, came out.Rod is bent and ridges are twisted.
Additional Manufacturer Narrative
The associated complaint device was not returned.A review of the production documentation for the corresponding products did not reveal any deviation from the standard manufacturing processes.A review of complaint history for the listed part revealed no prior complaints for the listed batch.We recommend that all re-usable instruments be routinely inspected for wear/damage and replaced as necessary.Without the actual product involved, our investigation cannot proceed.If the device or new information is received in the future, this complaint can be re-opened.We consider this investigation closed.

• Brand Name: GII LONG I/M ROD 16 INCH
• Common Device Name: PRSTHSIS,KN,PATLL/FMRTIBIAL,SMI-CNSTRND,UNCMNTD,PRS,COAD,OLYMER/METAL/POLYMER
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• MDR Report Key: 7653189
• Report Number: 1020279-2018-01239
• Device Sequence Number: 1645526
• Product Code: MBH
• UDI-Device Identifier: 03596010213723
• UDI-Public: 03596010213723
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K121393
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 06/29/2018

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: 71440004
• Device Lot Number: 12AM16620
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 06/05/2018
• Supplement Date Received by Manufacturer: 06/05/2018
• Initial Report FDA Received Date: 06/29/2018
• Supplement Report FDA Received Date: 10/05/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1