MAUDE Adverse Event Report: MDT PUERTO RICO OPERATIONS CO, MED REL CANNULATED LEGACY SCREWS; APPLIANCE, FIXATION, SPINAL INTERLAMINAL

Model Number	7570955
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/20/2026
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
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 multiple sources (healthcare provider, distributor) regarding a patient implanted with screw and set screw having l4-5 hemilaminectomy for nerve root decompression and l4-l5 fusion through the transforaminal approach (mis-tlif) therapy for l4-l5 disc herniation with nerve root compression.It was reported that after tightening the set screws and rechecking with c-arm fluoroscopy, two screw heads became detached from the two screw shafts.The reported event was identified intraoperatively on c-arm recheck, and the involved products were explanted. there was no patient symptom reported.There were no further complications reported regarding the event.

• Brand Name: CANNULATED LEGACY SCREWS
• Common Device Name: APPLIANCE, FIXATION, SPINAL INTERLAMINAL
• Manufacturer (Section D): MDT PUERTO RICO OPERATIONS CO, MED REL; road 909, km. 0.4., barrio mar; humacao PR 00792
• Manufacturer (Section G): MDT PUERTO RICO OPERATIONS CO, MED REL; road 909, km. 0.4., barrio mar; humacao PR 00792
• Manufacturer Contact: justin ellis ; 1800 pyramid place; memphis, TN 38132 ; 7635265677
• MDR Report Key: 25454623
• Report Number: 2647346-2026-00314
• Device Sequence Number: 8670451
• Product Code: KWP
• UDI-Device Identifier: 00885074457567
• UDI-Public: (01)00885074457567(11)240301(10)H5936009
• Combination Product (Y/N): N
• Initial Reporter Country: VM
• PMA/510(K) Number: K032265
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2026
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 07/03/2026

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: 7570955
• Device Catalogue Number: 7570955
• Device Lot Number: H5936009
• 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: 05/21/2026
• Supplement Date Received by Manufacturer: 06/17/2026
• Initial Report FDA Received Date: 06/10/2026
• Supplement Report FDA Received Date: 07/03/2026
• Date Device Manufactured: 03/01/2024
• 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 Sex: Male