MAUDE Adverse Event Report: SEASPINE ORTHOPEDICS CORPORATION SHORELINE ACS; INSERTER

Model Number	86-0010
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/23/2024
Type of Reportable Event	Malfunction
Event or Problem Description
The surgeon reported the tip of the shoreline acs inserter broke while performing surgery on (b)(6) 2024.The cage/plate was being impacted into the c6-c7 disc space when the threaded tip broke in the cage.The tip became stuck in the cage and the cage with the broken tip was implanted in the patient.The surgeon was unable to place the locking cover on the plate.The customer states there was a backup available, but the surgeon was pleased with the screw purchase and decided to leave as is.The event did not lead to a clinically relevant increase in the duration of the surgical procedure and the surgery was completed successfully.Customer confirms there was no patient injury and the issue did not require additional medical or surgical treatment.
Additional Manufacturer Narrative
H3: instrument has been returned, but outcome of the investigation is still pending.Review of labeling: intraoperative warnings.Breakage, slippage, or misuse of instruments or implant components may cause injury to the patient or operative personnel.
Additional Manufacturer Narrative
Update to h3: device evaluated by manufacturer changed to "yes".Investigation conclusion: the returned inserter instrument was visually inspected to confirm the failure mode outlined in the description of the complaint.After reviewing the instrument, it was confirmed that the tip of the inner draw rod sheared off from the component.The location of the break was about 1 to 1.5 thread turns past where the inner draw rod is exposed from the outer sleeve locating tips.Root cause: the reported complaint may be due to misuse, surgical technique, or excessive torsional force.These devices are part of loaner sets that are subject to handling and repeat use after distribution.Wear and damage can occur over time.Exact root cause unable to be determined.Review of labeling: intraoperative warnings breakage, slippage, or misuse of instruments or implant components may cause injury to the patient or operative personnel.

• Brand Name: SHORELINE ACS
• Common Device Name: INSERTER
• Manufacturer (Section D): SEASPINE ORTHOPEDICS CORPORATION; 5770 armada dr.; carlsbad CA 92008
• Manufacturer (Section G): SEASPINE ORTHOPEDICS CORPORATION; 5770 armada dr.; carlsbad CA 92008
• Manufacturer Contact: danielle nelson-archer ; 5770 armada dr.; carlsbad, CA 92008
• MDR Report Key: 21194464
• Report Number: 3012120772-2025-00004
• Device Sequence Number: 20943134
• Product Code: MAX
• UDI-Device Identifier: 10889981126889
• UDI-Public: 10889981126889
• Combination Product (Y/N): N
• Initial Reporter State: NV
• Initial Reporter Country: US
• PMA/510(K) Number: K240830
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 02/26/2025

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: 86-0010
• Device Catalogue Number: 86-0010
• Device Lot Number: AL683477J
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/31/2024
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/23/2024
• Supplement Date Received by Manufacturer: 02/06/2025
• Initial Report FDA Received Date: 01/20/2025
• Supplement Report FDA Received Date: 02/26/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 10/09/2023
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown