MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC QUICK RELEASE T-HANDLE; MISC ORTHO SURGICAL INSTR

Model Number	394.951
Medical Device Problem Code	Appropriate Device Problem Term/Code Not Available (3191)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The device was received, the investigation is in progress, no conclusion could be drawn at the time of filing this report.(b)(4).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) 2019 the sales consultant took hammers and trial shafts to be welded at a local machine shop per the surgeon¿s instructions.The instruments were spot welded twice, about 180 degrees offset and not a circumferential weld.The surgeon¿s practice is to use a general surgical hammer to insert and remove the trial.When the trials are hammed out for removal, the surgeon hits the underside of the device where the collar is to enable the release of the trial shaft as part of its modular design.During the removal the trial would detach from the t-handle when surgeon would hit the collar of t-handle as he was removing the trial from the disc space with the hospital mallet.The devices were returned to the surgeon after july 17, 2019 and were sterilized.The modified instruments were used in ten (10) cases.The instruments were removed from the facility on september 5, 2019.There were no adverse events, delays, malfunctions, fragments, or other medical interventions.This complaint involves twenty-one (21) devices.This report is for one (1) quick release t-handle.This is report 1 of 10 for (b)(4).This complaint is linked to (b)(4).
Additional Manufacturer Narrative
Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.Catalog number 394.951 updated.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.
Additional Manufacturer Narrative
Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.H10: additional narrative: h3, h4, h6: part: 394.951, lot: t180124: manufacturing site: tuttlingen.Release to warehouse date: july 02, 2019.A review of the device history records was performed for the finished device lot number, and no non-conformances were identified.H3, h6: a product investigation was completed: upon visual inspection, it is observed that the device was spot welded on two spots (unintended modification).The device was modified in a non depuysynthes facility.The rest of the device shows normal wear which would not contribute to the complaint condition.Thus, the reported complaint is confirmed.The relevant drawings were reviewed during the investigation; no design issues or discrepancies were noted during the investigation.The complaint is confirmed.Definitive root cause for the reported complaint is the device was modified in a non-depuy synthes facility.No product design or manufacturing issues were identified, and no new malfunctions were identified either.Based upon these results, no corrective and/or preventative action is proposed.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post market safety surveillance activities.H11: corrected data: g4: awareness date reported on follow up 1 report as september 05, 2019 but should have been october 22, 2019.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.

• Brand Name: QUICK RELEASE T-HANDLE
• Common Device Name: MISC ORTHO SURGICAL INSTR
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 9144638
• Report Number: 2939274-2019-61084
• Device Sequence Number: 19542508
• Product Code: LXH
• UDI-Device Identifier: 10705034777399
• UDI-Public: (01)10705034777399
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 09/05/2019

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 Model Number: 394.951
• Device Catalogue Number: 394.951
• Device Lot Number: T180124
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/30/2019
• Initial Date Received by Manufacturer: 09/05/2019
• Supplement Date Received by Manufacturer: 09/05/2019; 10/23/2019
• Initial Report FDA Received Date: 10/02/2019
• Supplement Report FDA Received Date: 10/22/2019; 10/24/2019
• Patient Sequence Number: 1