MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US SIGMA INSET PATELLA CLAMP HEAD; KNEE INSTRUMENT : PATELLA HANDLE/CLAMPS

Model Number	96-6683
Medical Device Problem Code	Device-Device Incompatibility (2919)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	02/18/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Product complaint # (b)(4).Examination of the returned devices confirmed the reported event.The returned device was manufactured prior to a product enhancement, and the investigation did not indicate that a broader investigation or corrective action was necessary depuy synthes considers the investigation closed at this time.Should additional information be received, the information will be reviewed and the investigation may be re-opened as necessary.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 the patella clamp and adapter will not hold.No surgical delay.

• Brand Name: SIGMA INSET PATELLA CLAMP HEAD
• Common Device Name: KNEE INSTRUMENT : PATELLA HANDLE/CLAMPS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• MDR Report Key: 9792439
• Report Number: 1818910-2020-06813
• Device Sequence Number: 11313796
• Product Code: HXD
• UDI-Device Identifier: 10603295249610
• UDI-Public: 10603295249610
• Combination Product (Y/N): N
• Initial Reporter State: NC
• Initial Reporter Country: US
• 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
• Report Date (Section B): 02/18/2020

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: 96-6683
• Device Catalogue Number: 966683
• Device Lot Number: TBJBL
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/25/2020
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/18/2020
• Initial Report FDA Received Date: 03/05/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1