MAUDE MDR 5370071

MDR report key
5370071
Report number
9612488-2016-10029
Event key
0
Event type
3
Date received
2016-01-15
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
LINDA PLEWS
Address
1302 WRIGHTS LANE EAST WEST CHESTER PA 19380 US
Phone
610-610-6107
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1TREPHINE ATTACHMENT 10.5MM DIAMETERTREPHINESYNTHES BETTLACHHWK387.6612677663Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12016-01-150

Event Narratives#

N

Patient 1

DEVICE IS AN INSTRUMENT AND IS NOT IMPLANTED/EXPLANTED. MANUFACTURING LOCATION: (B)(4). MANUFACTURING DATE: FEBRUARY 25, 2011. THE REVIEW OF THE DEVICE HISTORY RECORD SHOWED THAT THERE WERE NO ISSUES DURING THE MANUFACTURE OF THE PRODUCT THAT WOULD CONTRIBUTE TO THIS COMPLAINT CONDITION. THE DEVICE WAS RECEIVED, THE INVESTIGATION COULD NOT BE COMPLETED, AND NO CONCLUSION COULD BE DRAWN, AS PRODUCT IS ENTERING THE COMPLAINT SYSTEM. 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.

D

Patient 1

IT WAS REPORTED THAT UPON INSPECTION IT WAS NOTED THAT THE TREPHINE ATTACHMENT WAS BROKEN AT THE END OF THE INSTRUMENT. THE TIP WAS DESCRIBED AS SCALLOPED WITH ONE PRONG BROKEN OFF AND MISSING. THERE WAS NO PATIENT INVOLVEMENT. THIS IS REPORT 1 OF 1 FOR (B)(4).

N

Patient 1

A PRODUCT INVESTIGATION WAS COMPLETED: ONE (1) 10.5MM TREPHINE ATTACHMENT (PART 387.661, LOT 2677663, MANUFACTURED FEBRUARY 2011) WAS RETURNED WITH A COMPLAINT STATING THAT THE TIP WAS SCALLOPED WITH ONE PRONG BROKEN OFF AND MISSING. UPON EVALUATION OF THE RETURNED INSTRUMENT, ONE OF THE TEETH WAS COMPLETELY BROKEN OFF. THE COMPLAINT IS CONFIRMED. THE 10.5MM TREPHINE ATTACHMENT (PART 387.661) IS PART OF THE ORTHOPEDIC FOOT INSTRUMENTS SET AND IS INCLUDED IN THE BONE HARVESTING MODULE CASE. WHEN USED IN CONJUNCTION WITH THE SILICONE HANDLE (03.111.013) AND THE SHAFT FOR TREPHINE ATTACHMENT (03.111.030), THE TREPHINE ATTACHMENTS ARE INTENDED TO CUT THROUGH THE BONE AND EXTRACT BONE GRAFT. ALTERNATIVELY, EXTRACTION ATTACHMENTS CAN BE USED TO IF A BONE GRAFT CANNOT BE REMOVED WITH THE TREPHINE ATTACHMENTS. THE RELEVANT PRODUCT DRAWINGS WERE REVIEWED DURING THE INVESTIGATION. THE RETURNED TREPHINE ATTACHMENT WAS FOUND SUITABLE TO DETERMINE THE INTENDED DEVICE DESIGN, APPLICATION, AND DIMENSIONAL CONFORMITY. IT IS LIKELY THAT REPEATED USE AND EXCESSIVE FORCE OVER THE LAST FIVE (5) YEARS CONTRIBUTED TO THE COMPLAINT CONDITION. NO DESIGN ISSUES WERE NOTED AND SO NO CORRECTIVE ACTION IS WARRANTED AT THIS TIME. 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.