MAUDE Adverse Event Report: DEPUY MITEK LLC US RIGIDFIX FEM/TIB ROD THUMBSCR *EA; ORTHOPAEDIC IMPLANT INSERTER/EXTRACTOR

Catalog Number	213600
Medical Device Problem Code	Physical Resistance/Sticking (4012)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	02/02/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
If additional information should become available, a supplemental medwatch will be submitted accordingly.Udi: (b)(4)-incomplete.The lot number is currently unavailable.The complaint device was received and inspected.Visual observation revealed the screw is in normal worn condition.Functionally, it was tested using 8 mm femoral rod and the screw was able to hold it in place tightly with no issues.The device is not too big as reported.This compliant cannot be confirmed.We cannot determine what caused the user to experience the reported event, we cannot discern a root cause for the reported failure mode.Furthermore, no lot number was supplied which precludes conducting a dhr review or a lot specific search in the complaints handling system.At this point in time, no corrective action is required and no further action is warranted.However, depuy synthes mitek will continue to track any related complaints within this device family as a means of monitoring the extent with which this complaint is observed in the field.This report is being filed from the (b)(4) as required under mitek's corrective and preventative actions (capa) to file usa fda mdr missed malfunctions.
Event or Problem Description
This is report 3 of 4 for the same event.It was reported by the sales rep that the customer's rigidfix femoral 3.3mmst cross pin kit, rigidfix femoral st guide frame, rigidfix femoral/tibial rod thumb screw failed during an anterior cruciate ligament acl reconstruction surgical procedure.It was reported that the surgeon placed the guide frame in and they binded up then cold welded but was unable to take apart.The surgeon stated that all of the devices looked too big and not working correctly.The case was completed with another like device.There were no adverse patient consequences or time delay.There was patient involvement reported.There were no injuries, medical intervention or prolonged hospitalization.All available information has been disclosed.If additional information should become available, a supplemental medwatch report will be submitted accordingly.

• Common Device Name: ORTHOPAEDIC IMPLANT INSERTER/EXTRACTOR
• Manufacturer (Section D): DEPUY MITEK LLC US; 325 paramount drive; raynham MA 02767
• MDR Report Key: 8271372
• Report Number: 1221934-2018-53280
• Device Sequence Number: 1448712
• Product Code: LXH
• UDI-Device Identifier: 10886705002634
• UDI-Public: 10886705002634
• Combination Product (Y/N): N
• Initial Reporter State: AL
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 02/02/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Catalogue Number: 213600
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/06/2017
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/02/2017
• Initial Report FDA Received Date: 01/23/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1