MAUDE Adverse Event Report: SMITH & NEPHEW, INC. HEX SCREWDRIVER; PRSTHSS,KNEE,PTLLO/FMRTIBL,SMI-CNSTRND,UNCMNTD,PRS,CD,PLYMER/METAL/POLYMER

Catalog Number	115035
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	12/31/2018
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the surgeon states that the screwdriver broke during surgery.No pieces fell into the surgical field.Smith and nephew backup was used.There was no delay to the procedure, and there was no injury to the patient.
Additional Manufacturer Narrative
The associated device was returned and evaluated.A visual inspection of the returned device confirmed the stated failure mode.The tip of the hex section of the device fractured off and was not returned.The device exhibits signs of extensive wear/usage.At this time, we have no reason to suspect that the product failed to meet any product specifications at the time of manufacture.We recommend that all reusable instruments be routinely inspected for wear and damage and replaced as necessary.Based on this investigation, the need for corrective action is not indicated.Should additional information be received, the complaint will be reopened.No further investigation is warranted for this complaint; however we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.

• Brand Name: HEX SCREWDRIVER
• Common Device Name: PRSTHSS,KNEE,PTLLO/FMRTIBL,SMI-CNSTRND,UNCMNTD,PRS,CD,PLYMER/METAL/POLYMER
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• MDR Report Key: 8290914
• Report Number: 1020279-2019-00338
• Device Sequence Number: 1912286
• Product Code: MBH
• UDI-Device Identifier: 03596010052063
• UDI-Public: 03596010052063
• 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): 03/23/2019

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: 115035
• Initial Date Received by Manufacturer: 12/31/2018
• Supplement Date Received by Manufacturer: 12/31/2018
• Initial Report FDA Received Date: 01/30/2019
• Supplement Report FDA Received Date: 03/23/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1