MAUDE Adverse Event Report: NUVASIVE SPECIALIZED ORTHOPEDICS, INC. PRECICE SYSTEM; ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES

Model Number	P10.7-80B275
Medical Device Problem Codes	Mechanical Problem (1384); Migration (4003)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/29/2022
Type of Reportable Event	Malfunction
Event or Problem Description
Information was received that the nail stopped during the lengthening protocol.Per the reporter, the nail was moving inside the body part.No patient adverse event was reported.
Additional Manufacturer Narrative
The device has not been returned for evaluation.The root cause is unable to be determined at this time.If any additional information is provided, a supplemental report will be submitted.
Event or Problem Description
Additional information was received that "the thinner part is going inside the thicker part.It is loose".
Additional Manufacturer Narrative
H6 (device code 4003 was previously submitted.The reporter has confirmed this event was not a migration issue, but a mechanical issue).
Additional Manufacturer Narrative
Additional data: b5, h3, h6, h10.Device evaluation: upon return, visual inspection of the nail revealed no external damage.X-ray images of the internal components showed no damage and revealed the nail to have been partially distracted.The nail was functionally tested and was able to distract and retract without any abnormal noise using the high-speed magnet tool and the external remote controller (erc).The length as received was measured at 274.49 mm.The maximum and minimum length were measured at 355.57 mm and 273.12 mm respectively; giving a total stroke measurement of 82.45 mm, which meets the specification.Distraction force testing was measured at 292.40 lbs.Which meets the specification.The reported failure could not be confirmed as the nail was found to be functional and met the specifications.As part of this complaint investigation, there were no loose components found within the nail.Device records review: review of the device history records indicated, the unit met all required quality specifications and testing prior to product departure.
Event or Problem Description
No additional information has been provided.

• Brand Name: PRECICE SYSTEM
• Common Device Name: ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES
• Manufacturer (Section D): NUVASIVE SPECIALIZED ORTHOPEDICS, INC.; 101 enterprise dr ste 100; aliso viejo CA 92656
• Manufacturer (Section G): NUVASIVE SPECIALIZED ORTHOPEDICS, INC.; 101 enterprise dr ste 100; aliso viejo CA 92656
• Manufacturer Contact: geoff gannon ; 101 enterprise dr ste 100; aliso viejo, CA 92656
• MDR Report Key: 13690369
• Report Number: 3006179046-2022-00136
• Device Sequence Number: 17395635
• Product Code: HSB
• UDI-Device Identifier: 00812258020262
• UDI-Public: 812258020262
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K191336
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2022
• Device Explanted Year: 2022
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative,Distributor
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 04/18/2022

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: P10.7-80B275
• Device Lot Number: 1061102AAA
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/08/2022
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/21/2022
• Supplement Date Received by Manufacturer: 03/09/2022; 04/14/2022
• Initial Report FDA Received Date: 03/08/2022
• Supplement Report FDA Received Date: 03/11/2022; 04/18/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/11/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Age: 28 YR
• Patient Sex: Female
• Patient Weight: 47 KG