MAUDE Adverse Event Report: MSD DEGGENDORF MFG ANATOMIC PEEK PTC CERVICAL FUSION SYSTEM; INTERVERTEBRAL FUSION DEVICE WITH BONE GRAFT,

Model Number	5030141
Medical Device Problem Code	Migration (4003)
Health Effect - Clinical Code	Discomfort (2330)
Date of Event	03/15/2024
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
H6: neither the device nor films of applicable imaging studies were returned to the manufacturer for evaluation.Therefore, we are unable to determine the definitive cause of the reported event.Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Event or Problem Description
Information was received from healthcare provider (hcp) via a manufacturer representative regarding a patient having revision surgery.Pre-op diagnosis was cervical kyphosis.It was reported that, patient had discomfort due to plate dislodgement. after c5/6 decompression, 11mm cage was placed and migration of c5/6 cage already occurred after combined posterior fixation.After 1 week postoperatively, further migration of the cage and head side dislodgement of the c4-7 zevo plate occurred. total removal of plate and removal of  11mm cage at c5/6, autologous iliac bone transplantation between c5/6 vertebrae was retrieved during revision surgery.  the 13mm screw at c4 and 15mm screw at c7 was found loose and they were explanted.Procedure or technique performed during initial surgery was c4-7 anterior cervical discectomy and fusion.There were no particular problems with 5mm cage.  no further complications reported.

• Brand Name: ANATOMIC PEEK PTC CERVICAL FUSION SYSTEM
• Common Device Name: INTERVERTEBRAL FUSION DEVICE WITH BONE GRAFT,
• Manufacturer (Section D): MSD DEGGENDORF MFG; wertstrasse 17; deggendorf 94469 ; GM 94469
• Manufacturer (Section G): MSD DEGGENDORF MFG; wertstrasse 17; deggendorf 94469 ; GM 94469
• Manufacturer Contact: glen belmer ; 1800 pyramid place; memphis, TN 38132 ; 6122713209
• MDR Report Key: 19094240
• Report Number: 1030489-2024-00259
• Device Sequence Number: 12664293
• Product Code: ODP
• UDI-Device Identifier: 00643169357624
• UDI-Public: 00643169357624
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K133653
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Device Explanted Year: 2024
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 04/12/2024

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 Model Number: 5030141
• Device Catalogue Number: 5030141
• Device Lot Number: 62G
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/15/2024
• Initial Report FDA Received Date: 04/11/2024
• Date Device Manufactured: 10/25/2023
• 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: Required Intervention
• Patient Sex: Unknown