MAUDE Adverse Event Report: MEDOS INTERNATIONAL SÃ RL CH MNTR LS SCREW 3.5X36; ORTHOSIS, CERVICAL PEDICLE SCREW SPINAL FIXATION

Model Number	188320336
Medical Device Problem Code	Torn Material (3024)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	02/23/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Product complaint # (b)(4).Device is available for evaluation.Investigation will be conducted.Follow up will be filed with the investigation results.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Event or Problem Description
I was covering a spine case at (b)(6) hospital ((b)(4)) with dr.(b)(6).We were performing a posterior spine fusion of c1-c2 using mountaineer.The case went well until the surgeon went to use the final tightener on the set screw (1883-41-200) while tightening, the set screw began to spin freely inside the pilyaxial head of the long shank screw 3.5mm x 36mm (1886-20-336).The surgeon attempted to use a separate set screw and realized the polyaxial head must have stripped.At this point we decided to back out the screw and replace it with the same item.Once this was completed a new set screw threaded perfectly and completed the construct.I saved the stripped screw and damaged set screws.Patient consequence? :no is the information being submitted for this complaint all the details that are known/available regarding this event? : yes.
Additional Manufacturer Narrative
Product complaint # (b)(4).
Additional Manufacturer Narrative
Product complaint # (b)(4).Device evaluated by mfr: corrected.Visual examination of the returned screw features minimal signs of use beyond some light surface markings and discoloration.However, all of the threads inside of the tulip head have been torn off.This has left rounded edges where the threads were previously located.The damage is consistent across all of the threads of the tulip head.And only affects this one side.A review of the device history record was conducted.No issues were identified during the manufacturing and release of this product that could have contributed to the problem reported by the customer.All complaint trends will be evaluated as a part of the depuy spine monthly complaint review meeting.The root cause of the damage to the threads of the poly screw cannot be determined from the sample and the information provided.A potential root cause may be inadvertently cross threading an inner screw during insertion into the tulip head of this poly screw.This would place stress on the threads of the tulip head, potentially resulting in them becoming damaged or torn.As there has been no issue identified in the manufacturing or release of the device that could have contributed to the problem reported by the customer and no systemic trends were found, this complaint file will be closed with no further action required.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

• Brand Name: MNTR LS SCREW 3.5X36
• Common Device Name: ORTHOSIS, CERVICAL PEDICLE SCREW SPINAL FIXATION
• Manufacturer (Section D): MEDOS INTERNATIONAL SÃ RL CH; chemin-blanc 38; le locle 02400 ; SZ 02400
• MDR Report Key: 7350116
• Report Number: 1526439-2018-50247
• Device Sequence Number: 11001000
• Product Code: NKG
• UDI-Device Identifier: 10705034158167
• UDI-Public: (01)10705034158167
• Combination Product (Y/N): N
• Initial Reporter State: CO
• Initial Reporter Country: US
• PMA/510(K) Number: K041203
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 02/23/2018

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: 188320336
• Device Catalogue Number: 188320336
• Device Lot Number: 5150W
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/06/2018
• Initial Date Received by Manufacturer: 02/24/2018
• Supplement Date Received by Manufacturer: 02/24/2018; 04/20/2018
• Initial Report FDA Received Date: 03/19/2018
• Supplement Report FDA Received Date: 03/19/2018; 04/23/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 88 YR