MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC WASHER 7.0MM; BOLT,NUT,WASHER

Model Number	219.98
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Unspecified Infection (1930)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Additional patient identifier: (b)(6).Date of implant reported as (b)(6) 2018, exact date is not known.Without a lot number the device history records review could not be completed.Product was not returned.Based on the information available, it has been determined that no corrective and/or preventative action is proposed.This complaint will be accounted for and monitored via post market surveillance activities.If additional information is made available, the investigation will be updated as applicable.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 underwent an ankle procedure in (b)(6) 2018 to implant two (2) locking compression plate (lcp) one third tubular plates, one (1) 2.7/3.5mm variable angle locking compression plate (va-lcp) anterolateral distal tibia plate, one (1) 2.7/3.5mm variable angle locking compression plate (va-lcp) medial distal tibia plate, thirteen (13) 3.5mm cortex screws, twelve (12) 2.7mm va locking screws, one (1) 7.0mm washer, one (1) 4.0mm cannulated screw, and two (2) 4.0mm cancellous screws.Patient was returned to surgery on (b)(6) 2018 where all hardware was removed due to infection, inflammation, and delayed healing.Surgery was completed successfully with no delay.Patient status reported as okay.Patient is reported to be incarcerated and non-compliant.This report is for a 7.0mm washer this is report 7 of 9 for (b)(4).

• Brand Name: WASHER 7.0MM
• Common Device Name: BOLT,NUT,WASHER
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 7944655
• Report Number: 2939274-2018-54237
• Device Sequence Number: 2338225
• Product Code: HTN
• UDI-Device Identifier: 10886982156280
• UDI-Public: (01)10886982156280
• Combination Product (Y/N): N
• Initial Reporter State: VA
• Initial Reporter Country: US
• PMA/510(K) Number: PREAD
• 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): 09/17/2018

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: 219.98
• Device Catalogue Number: 219.98
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 09/17/2018
• Initial Report FDA Received Date: 10/08/2018
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 30 YR
• Patient Weight: 72