MAUDE Adverse Event Report: SMITH & NEPHEW, INC. GII DSH ART TRL 1-2 11MM; ORTHOPEDIC MANUAL SURGICAL INSTRUMENT

Catalog Number	71430456
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	04/20/2019
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that during tka the device broke.All pieces accounted for.No delay or injury reported.A back up device was available.
Additional Manufacturer Narrative
The associated devices were returned and evaluated.A visual inspection of the returned devices confirmed the stated failure mode.Small sections of both devices fractured off and were returned.The devices had some nicks and gouges in surface, particularly around the fracture sites.The devices were manufactured in 2010 and 2011 and exhibit signs of extensive wear/usage.A review of complaint history did not reveal additional complaints for the listed batches.A review of the manufacturing records did not reveal a manufacturing abnormality that could have caused or contributed to the reported incident.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 complaints will be reopened.No further investigation is warranted for these complaints; however, we will continue to monitor for future complaints and investigate as necessary.

• Brand Name: GII DSH ART TRL 1-2 11MM
• Common Device Name: ORTHOPEDIC MANUAL SURGICAL INSTRUMENT
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• MDR Report Key: 8604305
• Report Number: 1020279-2019-01894
• Device Sequence Number: 14043293
• Product Code: LXH
• UDI-Device Identifier: 03596010512628
• UDI-Public: 03596010512628
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: foreign,health professional,u
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 08/06/2019

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: 71430456
• Device Lot Number: 10KM18574
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/16/2019
• Initial Date Received by Manufacturer: 04/22/2019
• Supplement Date Received by Manufacturer: 05/21/2019; 05/21/2019
• Initial Report FDA Received Date: 05/13/2019
• Supplement Report FDA Received Date: 05/23/2019; 08/06/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1