MAUDE Adverse Event Report: SMITH & NEPHEW, INC. STEM EXTRACTOR UNIVERSAL JOINT; PROSTHSISHIPSMICONSTRAINEDMTALCRAMICPOLYMRCMNTDORNONPOROUSNCMNTD

Catalog Number	71355107
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	08/20/2019
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that during surgery, the green plastic spacer on the stem extractor tip broke off.The broken piece was retrieved and no broken pieces were left inside the patient.No injury.No delay and a backup device was available.
Additional Manufacturer Narrative
The associated device was returned and evaluated.A visual inspection of the returned device confirmed the stated failure mode.The plastic bushing on the device is missing.The device was manufactured in 2013 and exhibits signs of extensive wear/usage.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 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.

• Brand Name: STEM EXTRACTOR UNIVERSAL JOINT
• Common Device Name: PROSTHSISHIPSMICONSTRAINEDMTALCRAMICPOLYMRCMNTDORNONPOROUSNCMNTD
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• MDR Report Key: 9070290
• Report Number: 1020279-2019-03379
• Device Sequence Number: 3587955
• Product Code: LZO
• UDI-Device Identifier: 00885556223697
• UDI-Public: 00885556223697
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K121627
• 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): 10/11/2019

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: 71355107
• Device Lot Number: 13APG0022
• Initial Date Received by Manufacturer: 08/20/2019
• Supplement Date Received by Manufacturer: 08/20/2019
• Initial Report FDA Received Date: 09/16/2019
• Supplement Report FDA Received Date: 10/11/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1