MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC SCR-DRIVER-HEX Ø5 FLEX; SCREWDRIVERS

Model Number	357.406
Medical Device Problem Code	Contamination /Decontamination Problem (2895)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	03/05/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Investigation summary: product was not returned.Based on the information available, it has been determined that no corrective and preventative action is proposed.Device history lot: part #: 357.406, synthes lot number: 6918109, supplier lot number: 6918109, manufacturing site: synthes brandywine, release to warehouse date: jul 19, 2012, supplier: greatbatch medical.Device history review: review of the device history record(s) showed that there were no issues during the manufacture of this product, and any sub-components, which would contribute to this complaint condition.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
Device report from synthes reports an event in (b)(6) as follows: it was reported that on an unknown date that during an unknown procedure it was discovered that brown screwdriver handle is staining.There was no reported delay.No fragments generated and procedure was completed successfully.There was no patient consequence.This complaint involves seven (7) devices.This is report 3 of 7 for (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.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H10 additional narrative: corrected data- b3- updated event date to unknown since the staining of the device did not occur intra-operatively but was only discovered during the procedure.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: SCR-DRIVER-HEX Ø5 FLEX
• Common Device Name: SCREWDRIVERS
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 9911157
• Report Number: 2939274-2020-01650
• Device Sequence Number: 3423399
• Product Code: HXX
• UDI-Device Identifier: 10886982196293
• UDI-Public: (01)10886982196293
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 03/05/2020

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: 357.406
• Device Catalogue Number: 357.406
• Device Lot Number: 6918109
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 03/23/2020
• Supplement Date Received by Manufacturer: 04/02/2020
• Initial Report FDA Received Date: 04/01/2020
• Supplement Report FDA Received Date: 04/23/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SCR-DRIVER-HEX W/SPHERIC-HEAD Ø8; SCR-DRIVER-HEX W/SPHERIC-HEAD Ø8; SCR-DRIVER-HEX Ø5 FLEX; SCR-DRIVER-HEX Ø5 FLEX; SCR-DRIVER-HEX Ø5 FLEX