MAUDE Adverse Event Report: GLOBUS MEDICAL, INC. VICTORY; VICTORY BUTTRESS PLATE, 20MM

Model Number	1236.0020
Medical Device Problem Code	Migration (4003)
Health Effect - Clinical Code	Insufficient Information (4580)
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that a victory buttress plate is is found to be backing out against patient bone post-operatively.
Additional Manufacturer Narrative
The device was not available for evaluation.It was reported that a victory buttress plate migrated out of the patient bone.The provided imaging from (b)(6) 2024 and (b)(6) 2024 shows that the buttress plate was inserted into the vertebral body and migrated anteriorly in the image.It appears that the screw remained inside the buttress plate and the plate and screw migrated together.No determinations could be made as to the cause of the reported issue.

• Brand Name: VICTORY
• Common Device Name: VICTORY BUTTRESS PLATE, 20MM
• Manufacturer (Section D): GLOBUS MEDICAL, INC.; 2560 general armistead avenue; audubon PA 19403
• Manufacturer (Section G): GLOBUS MEDICAL, INC.; 2560 general armistead avenue; audubon PA 19403
• Manufacturer Contact: daniel paul ; 2560 general armistead avenue; audubon, PA 19403 ; 6109301800
• MDR Report Key: 20579183
• Report Number: 3004142400-2024-00245
• Device Sequence Number: 18305308
• Product Code: KWQ
• UDI-Device Identifier: 00193982534400
• UDI-Public: 00193982534400
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K232318
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 10/30/2024

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: 1236.0020
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 10/10/2024
• Initial Report FDA Received Date: 10/31/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• 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: Other
• Patient Age: 63 YR
• Patient Sex: Male