MAUDE Adverse Event Report: DEPUY SPINE INC MMSI SINGLE INNER SETSCREW; ORTHOSIS, SPONDYLOSTHESIS SPINAL FIXATION

Catalog Number 179712000

Device Problems Break (1069); Entrapment of Device (1212)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 11/29/2021

Event Type  malfunction  

Manufacturer Narrative

Product complaint # (b)(4).Additional product code: kwp; mni.Complainant part is expected to be returned for manufacturer review/ investigation but has yet to be received.The investigation could not be completed, no product was received; no conclusion could be drawn at the time of filing this report.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 Description

Device report from synthes reports an event in (b)(6) as follows: it was reported that on (b)(6) 2021, an osteoporotic patient underwent for cement augmentation.This was an mis procedure and vcffs screws used.During screw insertion, 2-screw head braked and come out on alignment sleeve, whereas screw shank was in the vertebral body itself.There was issue in innie (locking cap) insertion initially and innies threads were not engaging to the screw, and when surgeon tried to revise the screw, both the heads only came out.Total 2 screws and 4 innies damaged.Without removing fragments, the procedure was completed successfully with 60-minutes delay.The patient consequences were reported.Concomitant device reported: unknown insertion instrument (part# unknown, lot# unknown, quantity unknown).Unknown rod (part# unknown, lot# unknown, qty unknown).This complaint involves six (6) devices.This report is for (1) mmsi single inner setscrew.This report is 2 of 4 for (b)(4).

Manufacturer Narrative

Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.A manufacturing record evaluation was performed for the finished device product code: 179712000.Lot number: 286696.It was electronically reviewed and no non-conformances / manufacturing irregularities were identified during the manufacturing process.The product was released on: october 15, 2020.Photo investigation: the complaint device was not returned for investigation.The images of the items provided were reviewed.The single innie screw appeared to be stripped which could have resulted in the complaint condition.Manufacturing record evaluation revealed no non-conformance that could have contributed to this issue.Since the device was not returned, document/specification review, as-received condition and dimensional inspection could not be reviewed.Conclusion: the complaint condition can be confirmed based on the available information.A definitive assignable root cause was not determined.During the investigation, no product design issues, or discrepancies were observed.No manufacturing issues were noted during investigation.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post market safety surveillance activities.Therefore, it has been determined that no corrective and/or preventive action is proposed.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.

Manufacturer Narrative

Depuy synthese is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H3, h6: the device was received, the investigation could not be completed, and no conclusion could be drawn, as product is entering the complaint system.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.

Manufacturer Narrative

Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.If the information is unknown, not available or does not apply, the section/field of the form is left blank.H3, h6: a product investigation was completed: visual analysis of the returned sample revealed that the set screw was observed stripped, broken and bent from the threads.Embedded device condition cannot be confirmed as photos received do not enough evidence to confirm the reported condition.A dimensional inspection was unable to be performed due to post manufacturing damage.The observed condition of the device was consistent with a random component failure that may have been caused by exposure to unintended forces.As part of depuy synthes quality process, all devices are manufactured, inspected, and released to approved specifications.The current and manufactured to drawings were reviewed.The overall complaint was confirmed as the observed condition would contribute to the complained device issue.There is no indication that a design or manufacturing issue has caused the complaint condition and hence the root cause cannot be determined.Based on the investigation findings, it has been determined that no corrective and/or preventative action is proposed.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post-market safety surveillance activities.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.

• Brand Name: MMSI SINGLE INNER SETSCREW
• Type of Device: ORTHOSIS, SPONDYLOSTHESIS SPINAL FIXATION
• Manufacturer (Section D): DEPUY SPINE INC; 325 paramount drive; raynham MA 02767
• Manufacturer (Section G): BRIDGEWATER DISTRIBUTION; 50 scotland boulevard; bridgewater MA ; MA
• Manufacturer Contact: kara ditty-bovard ; 325 paramount drive; raynham, MA 02767 ; 6103142063
• MDR Report Key: 13101009
• MDR Text Key: 284129319
• Report Number: 1526439-2021-02658
• Device Sequence Number: 1
• Product Code: MNH
• UDI-Device Identifier: 10705034266671
• UDI-Public: (01)10705034266671
• Combination Product (y/n): N
• Reporter Country Code: IN
• PMA/PMN Number: K030383
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup,Followup

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/28/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: 179712000
• Device Lot Number: 286696
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 09/15/2022
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 10/15/2020
• Is the Device Single Use?: Yes
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Treatment: MIS TI CFX FEN POLY 7X45; MIS TI CFX FEN POLY 7X50; MMSI SINGLE INNER SETSCREW; MMSI SINGLE INNER SETSCREW; MMSI SINGLE INNER SETSCREW; UNKNOWN INSERTION INSTRUMENTS; UNKNOWN RODS