MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 2.4MM VA LOCKING SCREW STARDRIVE 18MM; SCREW, FIXATION, BONE

Model Number	02.210.118
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Codes	No Consequences Or Impact To Patient (2199); No Code Available (3191)
Date of Event	06/13/2018
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Patient information is unknown date of event: unknown.Additional product code: hrs.Implanted date: unknown.Explanted date: device has not been reported as explanted.Complainant part is not expected to be returned for manufacturer review/investigation.Without a lot number the device history records review could not be completed.The investigation could not be completed; no conclusion could be drawn, as no product was received.Device was used for treatment, not diagnosis.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
It was reported that on an unknown date, the variable angle locking screw did not lock into the volar distal radius plate.Both devices are currently implanted in the patient.It was unknown where the issue was observed.There was no patient consequence.This is report 2 of 2 for (b)(4).
Additional Manufacturer Narrative
Additional narrative: date of event was reported as (b)(6) 2018; however, the complaint event had already reported on (b)(6) 2018.(b)(6) 2018, may be the date the hardware was removed.Device was used for treatment, not diagnosis.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
It was reported the hardware was removed due to the screw not locking into the plate.
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.Additional narrative: code 3191 used to capture required surgical intervention and device removal.Corrected data: adverse event or product problem, outcomes attributed to adverse event.Patient codes.Device was used for treatment, not diagnosis.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
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.Date of event is provided as (b)(6) 2018.Description is updated.Date of explant is unknown.Device was used for treatment, not diagnosis.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
It was reported that on (b)(6) 2018, the variable angle locking screw did not lock into the volar distal radius plate.It was unknown where the issue was observed.Hardware removal was performed due to the screw not locking into the plate.It was reported that device was explanted on an unknown date.There was no patient consequence.
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.Device was used for treatment, not diagnosis.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
Further it was reported that hardware was removed on (b)(6) 2018 as screw didn¿t lock into plate.

• Brand Name: 2.4MM VA LOCKING SCREW STARDRIVE 18MM
• Common Device Name: SCREW, FIXATION, BONE
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 7681245
• Report Number: 2939274-2018-52842
• Device Sequence Number: 10924098
• Product Code: HWC
• UDI-Device Identifier: 10886982052957
• UDI-Public: (01)10886982052957
• Combination Product (Y/N): N
• Initial Reporter State: IA
• Initial Reporter Country: US
• PMA/510(K) Number: K103243
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Explanted Year: 2018
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup,Followup,Followup
• Report Date (Section B): 06/13/2018

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?: Yes
• Operator of Device: Health Professional
• Device Model Number: 02.210.118
• Device Catalogue Number: 02.210.118
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 06/13/2018
• Supplement Date Received by Manufacturer: 07/12/2018; 08/17/2018; 08/29/2018; 09/07/2018
• Initial Report FDA Received Date: 07/12/2018
• Supplement Report FDA Received Date: 07/26/2018; 08/28/2018; 09/07/2018; 09/10/2018
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention