MAUDE Adverse Event Report: TORNIER INC. AEQUALIS PERFORM REVERSED SHOULDER SYSTEM; SHOULDER PROSTHESIS SCREWDRIVER

Catalog Number MWJ127

Device Problem Device Operates Differently Than Expected (2913)

Patient Problem No Code Available (3191)

Event Date 01/26/2018

Event Type  malfunction  

Manufacturer Narrative

This is the final report submitted regarding this surgical event and medical device.

Event Description

The driver broke while tightening the glenosphere into the baseplate.Follow up with the complaint reporter revealed the tip of the screwdriver was not able to be removed from the patient and surgery time was extended while the surgeon tried to remove the tip.

• Brand Name: AEQUALIS PERFORM REVERSED SHOULDER SYSTEM
• Type of Device: SHOULDER PROSTHESIS SCREWDRIVER
• Manufacturer (Section D): TORNIER INC.; 10801 nesbitt avenue south; bloomington MN 55437
• Manufacturer Contact: matt kennedy ; 10801 nesbitt ave south; bloomington, MN 55437 ; 9526837482
• MDR Report Key: 7297220
• MDR Text Key: 101127863
• Report Number: 3004983210-2018-00005
• Device Sequence Number: 1
• Product Code: PHX
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K161742
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 02/07/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Physician
• Device Catalogue Number: MWJ127
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Initial Date Manufacturer Received: 02/07/2018
• Initial Date FDA Received: 02/26/2018
• 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: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other; Required Intervention