MAUDE Adverse Event Report: ZIMMER BIOMET SPINE INC. STANDARD CLOSURE TOP; VIRAGE OCT SPINAL FIXATION SYSTEM

Catalog Number	07.01728.001
Medical Device Problem Code	Migration (4003)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	04/06/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Without a product return, no product evaluation is able to be conducted.Current information is insufficient to permit a valid conclusion about the cause of this event.If additional information is obtained that adds value to the relevant content of this report and/or a conclusion can be drawn, a follow-up report will be sent.Reference reports 3012447612-2022-00120 through 3012447612-2022-00121.
Event or Problem Description
It was reported that a virage closure top migrated out of the screw, allowing the rod to move post-operatively.This was discovered via x-ray at the three week follow-up and a revision surgery was performed the next day to remove and replace the screw, rod, and closure top.This is report three of three for this event.
Event or Problem Description
It was reported that a virage closure top migrated out of the screw, allowing the rod to move post-operatively.This was discovered via x-ray at the three week follow-up and a revision surgery was performed the next day to remove and replace the screw, rod, and closure top.This is report three of three for this event.
Additional Manufacturer Narrative
Corrections in d4: udi number, d9, and h3.Additional information in h4 and h6: component, investigation type, findings, and conclusions.Device evaluation: the returned devices match the information in the complaint file and were examined.There is no damage to the screw or closure top.Root cause: the root cause was unable to be determined.This event could possibly be attributed to the force applied to the construct by patient activities.Dhr review: per dhr review, the parts were likely conforming when they left zimvie control.Device usage: this device is used for treatment.If additional information is obtained that adds value to the relevant content of this report, a follow-up report will be sent.

• Brand Name: STANDARD CLOSURE TOP
• Common Device Name: VIRAGE OCT SPINAL FIXATION SYSTEM
• Manufacturer (Section D): ZIMMER BIOMET SPINE INC.; 10225 westmoor dr.; westminster CO 80021
• Manufacturer (Section G): ZIMMER BIOMET SPINE INC.; 10225 westmoor dr.; na; westminster CO 80021
• Manufacturer Contact: kim martinez ; 10225 westmoor dr.; na; westminster, CO 80021 ; 3035144809
• MDR Report Key: 14246039
• Report Number: 3012447612-2022-00122
• Device Sequence Number: 11983845
• Product Code: KWP
• UDI-Device Identifier: 00889024328921
• UDI-Public: (01)00889024328921(10)T11272
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K133556
• 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
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 10/06/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Catalogue Number: 07.01728.001
• Device Lot Number: T11272
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• 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: 04/06/2022
• Supplement Date Received by Manufacturer: 09/18/2022
• Initial Report FDA Received Date: 04/28/2022
• Supplement Report FDA Received Date: 10/06/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/15/2021
• 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
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 70 YR
• Patient Sex: Male