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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC LOCK/NEUTRAL GUIDE F/4.5MM VA LCP CRVD CONDYLAR AIMING ARM; SCREW,FIXATION,BONE

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WRIGHTS LANE SYNTHES USA PRODUCTS LLC LOCK/NEUTRAL GUIDE F/4.5MM VA LCP CRVD CONDYLAR AIMING ARM; SCREW,FIXATION,BONE Back to Search Results
Model Number 03.231.007
Device Problem Device-Device Incompatibility (2919)
Patient Problem No Consequences Or Impact To Patient (2199)
Event Type  malfunction  
Manufacturer Narrative
Without a lot number the device history records review could not be completed.Product was not returned.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 Description
Device report from synthes reports an event in (b)(4) as follows: it was reported that on an unknown date, the trocar wouldn't clip in locking/neutral guide for the 4.5mm curved condylar plate aiming arm.No more information is available.Concomitant devices reported: unknown guides/sleeves/aiming: aiming arm (part# unknown, lot# unknown, quantity# 1) unknown plate (part# unknown, lot# unknown, quantity# 1).This report is for one (1) lock/neutral guide f/4.5mm va lcp crvd condylar aiming arm.This is report 2 of 2 for (b)(4).
 
Event Description
This is report 1 of 1 for (b)(4).
 
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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.Updated data-b5.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.
 
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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H10 additional narrative: h3, h4, h6: based on the information available, it has been determined that no corrective and/or preventative 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.
 
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Brand Name
LOCK/NEUTRAL GUIDE F/4.5MM VA LCP CRVD CONDYLAR AIMING ARM
Type of Device
SCREW,FIXATION,BONE
Manufacturer (Section D)
WRIGHTS LANE SYNTHES USA PRODUCTS LLC
1302 wrights lane east
west chester PA 19380
MDR Report Key9612852
MDR Text Key190489387
Report Number2939274-2020-00304
Device Sequence Number1
Product Code HWC
UDI-Device Identifier10886982077349
UDI-Public(01)10886982077349
Combination Product (y/n)N
PMA/PMN Number
K110354
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Type of Report Initial,Followup,Followup
Report Date 12/28/2019
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
Device Operator Health Professional
Device Model Number03.231.007
Device Catalogue Number03.231.007
Was Device Available for Evaluation? No
Initial Date Manufacturer Received 12/28/2019
Initial Date FDA Received01/21/2020
Supplement Dates Manufacturer Received02/05/2020
03/16/2020
Supplement Dates FDA Received02/17/2020
03/16/2020
Patient Sequence Number1
Treatment
UNK - GUIDES/SLEEVES/AIMING: AIMING ARM; UNK - PLATES
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