MAUDE Adverse Event Report: ARTHREX INC. LO-PRO SCREW,TI,4.5X 50MMCANN; SCREW, FIXATION, BONE

Catalog Number	AR-8945-50FT
Health Effect - Clinical Code	Pain (1994)
Date of Event	02/07/2018
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Patient demographics (age at time of event, date of birth, gender, weight) were requested but not provided.No further patient information was provided at the time of this report or made available in response to follow-up communication.No additional adverse consequences have been reported from this event.This device is used for treatment.Device history record review revealed nothing relevant to this event.The contribution of the device to the reported event could not be determined as the device was not returned for evaluation therefore the complainant's event could not be verified.The cause of the event could not be determined from the information available and without device evaluation the potential causes of this event are being communicated to the event reporter.If additional relevant information is received, a follow-up report will be submitted.
Event or Problem Description
It was reported that two broken screws were detected in a patient during the post op period.The two broken screws are reported to be ar-8945-50ft.The patient underwent shockwave therapy, as a palliative for attempted bone healing and pain reduction, but did not achieve significant improvement.Patient will be operated again in (b)(6).Original procedure date was (b)(6) 2017.Patient is a female.Follow-up investigation: it was reported that the revision surgery occurred (b)(6) 2018.Screws were explanted but will not be returned for evaluation.

• Brand Name: LO-PRO SCREW,TI,4.5X 50MMCANN
• Common Device Name: SCREW, FIXATION, BONE
• Manufacturer (Section D): ARTHREX INC.; 1370 creekside boulevard; naples FL 34108 1945
• MDR Report Key: 7303323
• Report Number: 1220246-2018-00073
• Device Sequence Number: 2378744
• Product Code: HWC
• UDI-Device Identifier: 00888867053786
• UDI-Public: 00888867053786
• Combination Product (Y/N): N
• Initial Reporter Country: BR
• PMA/510(K) Number: K103705
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2018
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Medical Equipment Company Technician/Representative
• Type of Report: Initial
• Report Date (Section B): 02/28/2018

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?: No
• Operator of Device: Health Professional
• Device Catalogue Number: AR-8945-50FT
• Device Lot Number: 784423
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/08/2018
• Initial Report FDA Received Date: 02/28/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other