MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC 3.0MM TI CERVICAL SPINE LOCKING SCREW 16MM-STERILE; INTERVERTEBRAL FUSION DEVICE W/INTEGRATED FIXATION,CERVICAL

Model Number	04.617.816.02S
Medical Device Problem Code	Device-Device Incompatibility (2919)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Complainant part is not expected to be returned for manufacturer review/investigation.Reporter is a synthes employee.Without a lot number the device history records review could not be completed.Product was not returned.Based on the information available, it has been determined that no corrective and/or preventative action is proposed.This complaint will be accounted for and monitored via post market surveillance activities.If additional information is made available, the investigation will be updated as applicable.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.
Event or Problem Description
It was reported that on an unknown date the titanium cervical spine locking screws were unable to lock into the plate.There were 2 screws that would not lock.A new pack of screws was opened and the 2 new screws were implanted and locked with no issues.There was no issue with the zero-p plate just the 2 screws.The surgery was completed successfully with no surgical delay.There were no patient consequences.Concomitant devices: unknown cage/plate (part#unknown, lot# unknown, quantity# 1), unknown screws: zero-p va (part#unknown, lot# unknown, quantity# 1).This report is for 1 3.0mm ti cervical spine locking screw 16mm-sterile.This is report 1 of 1 for (b)(4).

• Brand Name: 3.0MM TI CERVICAL SPINE LOCKING SCREW 16MM-STERILE
• Common Device Name: INTERVERTEBRAL FUSION DEVICE W/INTEGRATED FIXATION,CERVICAL
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 10015144
• Report Number: 2939274-2020-02158
• Device Sequence Number: 16911804
• Product Code: OVE
• UDI-Device Identifier: 20705034742301
• UDI-Public: 20705034742301
• Combination Product (Y/N): N
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: K093762
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 04/15/2020

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
• Operator of Device: Health Professional
• Device Model Number: 04.617.816.02S
• Device Catalogue Number: 04.617.816.02S
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 04/15/2020
• Initial Report FDA Received Date: 04/30/2020
• Patient Sequence Number: 1