MAUDE Adverse Event Report: INTEGRA LIFESCIENCES CORPORATION OH/USA MAYFIELD SPINE TABLE ADAPTOR METAL; BASE UNITS AND ADAPTERS

Model Number	A2600M
Medical Device Problem Codes	Mechanical Problem (1384); Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Device history record (dhr): the dhr was reviewed and shows no abnormalities related to the reported failure.The mayfield spine table adaptor (a2600m) was returned for evaluation.Complaint confirmed via inspection of the unit.Unit received with the shock cushion worn from routine use.The 6-inch transitional teeth were worn and it needed to be replaced.Repair also noted the connecting tube of the unit was flaking.General maintenance, cleaning and replacement of worn components required.No further investigation required based on the acceptability of risk and no adverse trends identified.This will be monitored and trended going forward.
Event or Problem Description
A facility reported that the shock cushion on the mayfield spine table adaptor (a2600m) was dislodged and it would not lock safely.It is unknown if there was patient involvement; however, no patient injury was reported or surgical delay has been reported.

• Brand Name: MAYFIELD SPINE TABLE ADAPTOR METAL
• Common Device Name: BASE UNITS AND ADAPTERS
• Manufacturer (Section D): INTEGRA LIFESCIENCES CORPORATION OH/USA; 4900 charlemar drive; 4900 charlemar drive; cincinnati OH
• MDR Report Key: 12022003
• Report Number: 3004608878-2021-00413
• Device Sequence Number: 11589233
• Product Code: FWZ
• UDI-Device Identifier: 10381780268062
• UDI-Public: 10381780268062
• Combination Product (Y/N): N
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: company representative,user f
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 06/17/2021

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: A2600M
• Device Catalogue Number: A2600M
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/01/2021
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 05/27/2021
• Initial Report FDA Received Date: 06/17/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1