BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TI LCP DISTAL FEMUR PLATE 7 HOLES/196MM/LEFT-STERILE

    MDR report key: 2915686 · Received January 15, 2013

    Report

    Report Number
    2520274-2013-00347
    Event Type
    Malfunction
    Date Received
    January 15, 2013
    Date of Event
    May 16, 2008
    Report Date
    February 16, 2009
    Manufacturer
    SYNTHES
    Product Code
    HRS
    PMA / PMN Number
    K062564
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE WAS USED FOR TREATMENT. THIS INDIVIDUAL ADVERSE EVENT REPORT IS BEING MADE IN ACCORDANCE WITH THE SYNTHES MDR EXEMPTION REQUEST DATED OCTOBER 2011. A REVIEW OF THE EVENTS ASSOCIATED WITH THE REQUEST WAS PERFORMED AND IT WAS DETERMINED THAT NONE OF THE EVENTS CONSTITUTES SYSTEMIC ISSUES RELATED TO PRODUCT QUALITY, CHANGES IN PRODUCT DESIGN, METHOD OF USE, OR CHANGES IN EXPECTED RISK THRESHOLDS. REVIEW OF THE DATA ALSO INDICATED NO SIGNIFICANT CHANGE IN RISK/BENEFIT OF EACH PRODUCT CATEGORY, NO EVIDENCE OF DEFICIENCIES IN THE DESIGN, LABELING, OR MANUFACTURE OF THE DEVICE. AS NO LOT NUMBER WAS PROVIDED, NO DEVICE HISTORY RECORD REVIEW CAN BE PERFORMED. THE DEVICE IS NOT BEING RETURNED FOR EVALUATION, NO FURTHER INFORMATION IS AVAILABLE ON THIS EVENT. NO FURTHER INVESTIGATION CAN BE PERFORMED.

    Description of Event or Problem · 1

    (B)(4) COMPLAINT HANDLING UNIT REPORTED A SCREW WAS BLOCKED IN THE PLATE. DURING THE REMOVAL, THE HEX SCREW HEAD WAS DAMAGED. THE REMOVAL SCREW ALSO BROKE IN THE SCREW HEAD. THE IMPLANT DATE IS UNKNOWN SINCE THEY WERE IMPLANTED IN ANOTHER HOSPITAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    22745 TI LCP DISTAL FEMUR PLATE 7 HOLES/196MM/LEFT-STERILE TI LCP DISTAL FEMUR PLATE HRS SYNTHES

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention