MAUDE Adverse Event Report: PARAGON 28, INC BABY GORILLA/GORILLA PLATING SYSTEMBABY GORILLA/GORILLA PLATING SYSTEM; OLIVE WIRE, THREADED, 1.3MM

Model Number P99-201-1306

Device Problem Break (1069)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 01/08/2024

Event Type  malfunction  

Event Description

The olive wire broke during removal from within a cannulated screw.The wire remnant is non-prominent within the patient.

Manufacturer Narrative

Updated & corrected items - d9, h2, h3, h6.

• Brand Name: BABY GORILLA/GORILLA PLATING SYSTEMBABY GORILLA/GORILLA PLATING SYSTEM
• Type of Device: OLIVE WIRE, THREADED, 1.3MM
• Manufacturer (Section D): PARAGON 28, INC; 14445 grasslands dr; englewood CO 80112
• Manufacturer Contact: jenny conger ; 14445 grasslands dr; englewood, CO 80112 ; 7203721212
• MDR Report Key: 18586512
• MDR Text Key: 334727668
• Report Number: 3008650017-2024-00010
• Device Sequence Number: 1
• Product Code: HXI
• Combination Product (y/n): N
• Reporter Country Code: SF
• 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,Followup
• Report Date: 01/26/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/26/2024
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: P99-201-1306
• Device Catalogue Number: P99-201-1306
• Was Device Available for Evaluation?: Yes
• Date Manufacturer Received: 01/08/2024
• Was Device Evaluated by Manufacturer?: Yes
• 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
• Patient Sex: Female