MAUDE Adverse Event Report: GLOBUS MEDICAL, INC. XTEND; XTEND 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 16MM

Model Number	161.016
Health Effect - Clinical Code	Insufficient Information (4580)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Neither the device or any imaging could be provided for evaluation.No determinations can be made as to the cause of the reported issue.
Event or Problem Description
It was reported that the c5 screw backed out of the plate post-operatively.A revision was done to remove the plate and screws.

• Brand Name: XTEND
• Common Device Name: XTEND 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 16MM
• Manufacturer (Section D): GLOBUS MEDICAL, INC.; 2560 general armistead avenue; audubon 19403
• MDR Report Key: 10637329
• Report Number: 3004142400-2020-00130
• Device Sequence Number: 19599479
• Product Code: KWQ
• UDI-Device Identifier: 00849044087789
• UDI-Public: 00849044087789
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K092146
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2020
• Device Explanted Year: 2020
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 10/05/2020

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: 161.016
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 09/14/2020
• Initial Report FDA Received Date: 10/06/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other