MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 5.0MM TI LOCKING SCREW W/T25 STARDRIVE 44MM F/IM NAIL-STER; SCREW,FIXATION,BONE

Model Number	04.005.534S
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Unspecified Infection (1930); Skin Erosion (2075)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Patient identifier and weight not available for reporting.Date of patient infection is not known.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 patient was implanted with a 10mm cannulated tibial nail, 5.0mm locking screw, 3.5mm locking compression plate (lcp) fibula plate, and six (6) unknown 3.5mm cortex screws on (b)(6) 2018.On unknown date patient developed skin breakdown and infection at the implant site.Patient was returned to surgery on (b)(6) 2018 where all hardware was removed.An antibiotic rod was placed until patient infection is cleared.Surgery was completed successfully with no delay.Patient status reported as stable.This report is for one (1) 5.0mm locking screw.This is report 2 of 4 for (b)(4).

• Brand Name: 5.0MM TI LOCKING SCREW W/T25 STARDRIVE 44MM F/IM NAIL-STER
• 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: 7687593
• Report Number: 2939274-2018-52877
• Device Sequence Number: 1397925
• Product Code: HWC
• UDI-Device Identifier: 10886982086037
• UDI-Public: (01)10886982086037
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K172157
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2018
• Device Explanted Year: 2018
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 06/21/2018

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?: No
• Operator of Device: Health Professional
• Device Model Number: 04.005.534S
• Device Catalogue Number: 04.005.534S
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 06/21/2018
• Initial Report FDA Received Date: 07/13/2018
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 34 YR