BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SYNFIX® EVOLUTION AIMING DEVICE HOLDER

    MDR report key: 9280214 · Received November 5, 2019

    Report

    Report Number
    2939274-2019-61979
    Event Type
    Malfunction
    Date Received
    November 5, 2019
    Report Date
    October 18, 2019
    Manufacturer
    WRIGHTS LANE SYNTHES USA PRODUCTS LLC
    Product Code
    HWA
    UDI-DI
    10705034814100
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 0

    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. INVESTIGATION FLOW: DEVICE INTERACTION/FUNCTIONAL. VISUAL INSPECTION: THE SYNFIX® EVOLUTION AIMING DEVICE HOLDER (PART # 03.835.004 / LOT # 1L83789) WAS RECEIVED AT US CQ ASSEMBLED WITH SYNFIX® EVOLUTION AIMING DEVICE/17MM & 19MM (PART # 03.835.003/ LOT # 9910647). THE TWO DEVICES WERE UNABLE TO DISASSEMBLE. THE AIMING DEVICE DOES NOT SIT FLUSH WITH THE DEVICE HOLDER. THE DEVICES WERE ALIGNED CORRECTLY BASED ON THE ALIGNMENT ETCHES. THE DEVICE HOLDER WAS JAMMED AND CANNOT BE ENGAGED TO RELEASE THE AIMING DEVICE. THERE WAS NO EVIDENCE OF A PHYSICAL BREAKAGE THUS THE REPORTED CONDITION OF BROKEN WAS NOT CONFIRMED. FUNCTIONAL TEST: FUNCTIONAL TESTING WITH THE RETURNED DEVICES SHOWED THAT THE AIMING DEVICE HOLDER WAS NOT ABLE TO BE PUSHED PROXIMALLY AND WAS JAMMED IN THE RECEIVED STATE. DUE TO JAMMED CONDITION, THE DEVICE WAS NOT ABLE TO RELEASE THE AIMING DEVICE THUS THE DEVICES WERE UNABLE TO DISASSEMBLE. THE REPORTED CONDITION OF UNABLE TO DISASSEMBLE WAS CONFIRMED, THE OVERALL COMPLAINT WAS CONFIRMED. CAN THE COMPLAINT BE REPLICATED WITH THE RETURNED DEVICE(S)? YES; AS-RECEIVED STATE CANNOT BE UNDONE. DEVICES DO NOT DISASSEMBLE. DIMENSIONAL INSPECTION: DUE TO THE INABILITY TO DISASSEMBLE, THE INTERNAL COMPONENTS OF THE DEVICE HOLDER CANNOT BE ASSESSED. DOCUMENT/SPECIFICATION REVIEW: DRAWING(S) REVIEWED: (CURRENT & MANUFACTURED REVISIONS). SE_513448_REVH AND G [DEVICE HOLDER]. SE_507695_REVL AND K [AIMING DEVICE]. CONCLUSION: THE OVERALL COMPLAINT WAS CONFIRMED FOR THE RECEIVED SYNFIX® EVOLUTION AIMING DEVICE HOLDER (PART # 03.835.004 / LOT # 1L83789) AS THE DEVICE WAS FUNCTIONALLY JAMMED AND WAS UNABLE TO DISASSEMBLE WITH THE RECEIVED AIMING DEVICE. ALTHOUGH NO DEFINITIVE ROOT-CAUSE CAN BE DETERMINED, IT IS POSSIBLE THAT THE COMPONENTS EXPERIENCED UNINTENDED FORCES LEADING TO AN INTERNAL MECHANICAL FAILURE. THERE WAS NO INDICATION THAT A DESIGN OR MANUFACTURING ISSUE CONTRIBUTED TO THE COMPLAINT. NO DESIGN ISSUES WERE OBSERVED DURING THE DOCUMENT/SPECIFICATION REVIEW. BASED ON THE INVESTIGATION FINDINGS, IT HAS BEEN DETERMINED THAT NO CORRECTIVE AND/OR PREVENTATIVE ACTION IS PROPOSED. ADDITIONAL MONITORING FOR ANY POTENTIAL SAFETY SIGNALS WILL BE CONDUCTED THROUGH COMPLAINT TRENDING AND OTHER POST MARKET SAFETY SURVEILLANCE ACTIVITIES. DEVICE HISTORY LOT . PART: 03.835.004. LOT: 1L83789. MANUFACTURING SITE: HÄGENDORF. RELEASE TO WAREHOUSE DATE: OCT 26, 2018. A MANUFACTURING RECORD EVALUATION WAS PERFORMED FOR THE FINISHED DEVICE LOT NUMBER, AND NO NON-CONFORMANCES WERE IDENTIFIED. 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.

    Additional Manufacturer Narrative · 1

    THE DEVICE WAS RECEIVED, THE INVESTIGATION IS IN PROGRESS, NO CONCLUSION COULD BE DRAWN AT THE TIME OF FILING THIS REPORT. 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.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT ON AN UNKNOWN DATE, DURING ROUTINE INCOMING INSPECTION, IT WAS OBSERVED THAT THE AIMING DEVICE HOLDER WAS BROKEN. THERE WAS NO KNOWN PATIENT OR HOSPITAL INVOLVEMENT. THIS COMPLAINT INVOLVES ONE (1) DEVICE. THIS REPORT IS FOR ONE (1) SYNFIX® EVOLUTION AIMING DEVICE HOLDER. THIS IS REPORT 1 OF 1 FOR (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1074199 SYNFIX® EVOLUTION AIMING DEVICE HOLDER IMPACTOR HWA WRIGHTS LANE SYNTHES USA PRODUCTS LLC 03.835.004 1L83789 10705034814100

    Patients

    Seq Age Sex Outcome Treatment
    1