MAUDE Adverse Event Report: BIOMET MICROFIXATION LACTOSORB SYSTEM 1.5MM SELF-DRILLING LACTOSORB TAP; TAP, BONE

Model Number	N/A
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	12/05/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Zimmer biomet complaint (b)(4).The user facility is foreign; therefore a facility medwatch report will not be available.Report source ¿ (b)(6).The complaint is confirmed.The tap was returned for evaluation.On visual inspection, the tap was found to have fractured near the base of the tap.The dhr was reviewed and there were no non-conformances were found.For this part (915-1595-01) and the previous three years (from the notification date) regarding the tap fracturing, there is a complaint rate of 0.2%, which is no greater than the occurrence listed in the application fmea.The most likely underlying cause of the complaint is the tap experienced force in excess of what it was designed to encounter; fractures at this point of the tap are typical of excessive force fractures.If any further information is found which would change or alter any conclusions or information, a supplemental report will be filed accordingly.Zimmer biomet will continue to monitor for trends.
Event or Problem Description
It was reported the instrument fractured when being used on the lower edge of the patient's eye socket.No adverse events have been reported as a result of the malfunction.

• Brand Name: LACTOSORB SYSTEM 1.5MM SELF-DRILLING LACTOSORB TAP
• Common Device Name: TAP, BONE
• Manufacturer (Section D): BIOMET MICROFIXATION; 1520 tradeport drive; jacksonville FL 32218
• MDR Report Key: 9762685
• Report Number: 0001032347-2020-00128
• Device Sequence Number: 14213384
• Product Code: HWX
• UDI-Device Identifier: 00841036125653
• UDI-Public: 00841036125653
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: foreign,health professional,u
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 02/27/2020

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: N/A
• Device Catalogue Number: 915-1595
• Device Lot Number: 557203
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 01/13/2020
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/24/2020
• Initial Report FDA Received Date: 02/27/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement: N/A
• Patient Sequence Number: 1