MAUDE Adverse Event Report: STRYKER GMBH STANDARD LAG SCREW OMEGA 110MM LENGTH; APPLIANCE, FIXATION, NAIL/BLADE/PLATE COMBINATION, MULTIPLE COMPONENT

Catalog Number	33625110
Medical Device Problem Codes	Fracture (1260); Material Deformation (2976)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	06/09/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Upon completion of investigation, additional information will be provided in a supplemental report.
Event or Problem Description
The customer reported that when inserting the lag screw the end sheared off the inserter.They were able to remove the lag screw.Another lag screw was then inserted and the operation completed.The dhs lag screw was inserted using the 1 step insertion technique.
Event or Problem Description
The customer reported that when inserting the lag screw the end sheared off the inserter.They were able to remove the lag screw.Another lag screw was then inserted and the operation completed.The dhs lag screw was inserted using the 1 step insertion technique.
Additional Manufacturer Narrative
The reported event could be confirmed.Based on investigation, the root cause was attributed to be user related.The failure was caused by inadequate assembly or simply too much mechanical force was applied during lag screw insertion (possibly the connecting bolt may have not been place tighten enough and subsequently the pins of the one step insertion wrench were not in position anymore).The device inspection revealed the following: the returned lag screw is indeed badly damaged (both connecting pins (pegs) are completely deformed / broken off).It indicates that either the lag screw had not been properly assembled with the one step insertion wrench or just inadequate use has resulted in these damages.The threaded front part is still in good condition though, which indicates that the user must have encountered difficulties with the correct assembly.A review of the device history for the reported lot did not indicate any abnormalities.No corrective actions are required at this time.A review of the labeling did not indicate any abnormalities.No indications of material, manufacturing or design related problems were found during the investigation.If any further information is provided, the investigation report will be updated.

• Brand Name: STANDARD LAG SCREW OMEGA 110MM LENGTH
• Common Device Name: APPLIANCE, FIXATION, NAIL/BLADE/PLATE COMBINATION, MULTIPLE COMPONENT
• Manufacturer (Section D): STRYKER GMBH; bohnackerweg 1; postfach; selzach 2545 ; CH 2545
• MDR Report Key: 8767003
• Report Number: 0008031020-2019-00778
• Device Sequence Number: 19249667
• Product Code: KTT
• UDI-Device Identifier: 07613327092899
• UDI-Public: 07613327092899
• Combination Product (Y/N): N
• Initial Reporter Country: GB
• PMA/510(K) Number: K955306
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Nurse
• Type of Report: Initial,Followup
• Report Date (Section B): 09/06/2019

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 Expiration Date: 01/31/2024
• Device Catalogue Number: 33625110
• Device Lot Number: B90657
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/05/2019
• Initial Date Received by Manufacturer: 06/10/2019
• Supplement Date Received by Manufacturer: 08/12/2019
• Initial Report FDA Received Date: 07/08/2019
• Supplement Report FDA Received Date: 09/06/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1