MAUDE Adverse Event Report: DEPUY SYNTHES SPINE VIPER; ORTHOSIS, SPINAL PEDICLE FIXATION

Model Number 186727945

Device Problem Loose or Intermittent Connection (1371)

Patient Problems Failure of Implant (1924); Injury (2348)

Event Date 10/26/2017

Event Type  Injury  

Manufacturer Narrative

A complaint investigation will be performed.The complaint product is not available for the investigation.A supplemental report is not anticipated unless the results of the complaint investigation identify a corrective action or additional relevant information.Should the product become available, a physical evaluation will be conducted and a supplemental report filed with the results.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.Device not returned for evaluation.

Event Description

Revision surgery.Two loose expedium 7mm poly screw in l5 were replaced thrue a viper cfx 9x45mm screw.For both screws the 9mm viper tab was used the full length of the screw.But afterwards both screws got stuck in the pedicle when the 4-fold thread of the screws was turned into the bone.No way for screwing or unscrewing.The surgeon had to remove pedicle-bone until the 4-fold thread was free und the screws could be unscrewed.Both 9x45 cfx screws were not usable after removal.Afterwards 8mm cfx screws were used.

• Brand Name: VIPER
• Type of Device: ORTHOSIS, SPINAL PEDICLE FIXATION
• Manufacturer (Section D): DEPUY SYNTHES SPINE; 325 paramount drive; raynham MA 02767
• Manufacturer (Section G): MEDOS INTERNATIONAL SARL; chemin blanc 38; le locle CH-24 00; SZ CH-2400
• Manufacturer Contact: jason busch ; 325 paramount drive; raynham, MA 02767 ; 5088808201
• MDR Report Key: 7036455
• MDR Text Key: 92155377
• Report Number: 1526439-2017-10989
• Device Sequence Number: 1
• Product Code: MNI
• UDI-Device Identifier: 10705034282893
• UDI-Public: (01)10705034282893
• Combination Product (y/n): N
• Reporter Country Code: GM
• PMA/PMN Number: K160879
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 10/18/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/16/2017
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Physician
• Device Model Number: 186727945
• Device Catalogue Number: 186727945
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 10/18/2017
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Type of Device Usage: N
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention