BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COUPLING SCREW FOR INSERTION OF DHS BLADES

    MDR report key: 2925905 · Received January 22, 2013

    Report

    Report Number
    2520274-2013-00575
    Event Type
    Malfunction
    Date Received
    January 22, 2013
    Date of Event
    August 31, 2009
    Report Date
    September 8, 2009
    Manufacturer
    SYNTHES
    Product Code
    LXH
    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

    EU COMPLAINT HANDLING UNIT REPORTED A THREAD BROKE OFF. AFTER INSERTION OF A DYNAMIC HIP SYSTEM BLADE, THE CONNECTION SCREW WAS ENGAGED BUT IT FAILED. THE BREAKAGE OF THE TIP OF THE SCREW WAS FOUND. THE BROKEN FRAGMENT WAS LEFT IN PATIENT. THE BLADE WAS NOT REPLACED AS THE FRACTURE WAS STABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    31202 COUPLING SCREW FOR INSERTION OF DHS BLADES COUPLING SCREW FOR INSERTION LXH SYNTHES

    Patients

    Seq Age Sex Outcome Treatment
    1