MAUDE Adverse Event Report: GLOBUS MEDICAL, INC. PLYMOUTH LLIF PLATE SYSTEM; PLYMOUTH THORACOLUMBAR PLATE, L4-L5, 15MM

Model Number 1105.3009

Device Problem Improper or Incorrect Procedure or Method (2017)

Patient Problem Insufficient Information (4580)

Event Type  malfunction  

Manufacturer Narrative

This report is being resubmitted for an incident that occurred earlier.The device was not available for evaluation as it remains in the patient.No determinations could be made as to the cause of the reported issue.

Event Description

It was reported that screws are backing out of post operatively.

• Brand Name: PLYMOUTH LLIF PLATE SYSTEM
• Type of Device: PLYMOUTH THORACOLUMBAR PLATE, L4-L5, 15MM
• Manufacturer (Section D): GLOBUS MEDICAL, INC.; 2560 general armistead avenue; audubon PA 19403
• Manufacturer (Section G): GLOBUS MEDICAL, INC.; 2560 general armistead avenue; audubon PA 19403
• Manufacturer Contact: daniel paul ; 2560 general armistead avenue; audubon, PA 19403 ; 6109301800
• MDR Report Key: 18837934
• MDR Text Key: 337211401
• Report Number: 3004142400-2023-00149
• Device Sequence Number: 1
• Product Code: KWQ
• UDI-Device Identifier: 00889095028188
• UDI-Public: 00889095028188
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K120092
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date: 03/01/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/05/2024
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 1105.3009
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 08/24/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Other