MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 1.5MM RAPID RESORBABLE STRUT PLATE 2 HOLESX18 HOLES-STERILE; BONE PLATE

Model Number	851.421.01S
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Unspecified Infection (1930); No Code Available (3191)
Date of Event	07/01/2017
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Expiration date and lot number unknown.Complainant part is not expected to be returned for manufacturer review/investigation.(b)(4).Without a lot number, the device history records review could not be completed as no product was received.The investigation could not be completed; no conclusion could be drawn at the time of filing this report.Investigation summary product was not returned.Based on the information available, it has been determined that no corrective and preventive 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 that on (b)(6) 2017, a hardware removal of rapid resorbable strut plate was performed due to infection.There was an unknown allegation against the battery pack-sterile for battery powered driver.On an unknown date, the patient presented with fever and infection at the surgical site.The parents admitted allowing their dog to lick the wound site on babies head that probably caused the infection.Initially, the patient had a sagittal synostosis procedure on (b)(6) 2017.It is unknown if there was a surgical delay.Procedure outcome and patient status were unknown.This complaint involves one (1) device.This report is 1 of 5 for (b)(4).

• Brand Name: 1.5MM RAPID RESORBABLE STRUT PLATE 2 HOLESX18 HOLES-STERILE
• Common Device Name: BONE PLATE
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 8755703
• Report Number: 2939274-2019-58986
• Device Sequence Number: 2042994
• Product Code: JEY
• UDI-Device Identifier: 10887587063713
• UDI-Public: (01)10887587063713
• Combination Product (Y/N): N
• Initial Reporter State: OR
• Initial Reporter Country: US
• PMA/510(K) Number: K062789
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 06/05/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: 851.421.01S
• Device Catalogue Number: 851.421.01S
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 06/05/2019
• Initial Report FDA Received Date: 07/02/2019
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 6 MO