MAUDE Adverse Event Report: WRIGHTS LANE SYNTHES USA PRODUCTS LLC POSITION-INSTR F/POLYAXIAL SCREW HEADS F; MISC ORTHO SURGICAL INSTR

Catalog Number	03.632.037
Medical Device Problem Code	Device Operates Differently Than Expected (2913)
Health Effect - Clinical Code	Not Applicable (3189)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Additional narrative: reportedly there was no patient involvement.Date of event is unknown.Device is an instrument and is not implanted/explanted.A device history record review was performed for the subject device: part # 03.632.037, synthes lot # 6696065, supplier lot # 6696065, release to warehouse date: 30 nov 2011 , supplier: (b)(4), no ncr's were generated during production.Review of the device history record(s) showed that there were no issues during the manufacture of this product, and any sub-components, which would contribute to this complaint condition.A product development investigation was performed for the subject device: it was reported that the polyaxial head placement tool (03.632.037 lot 6696065) was not functioning during set inspection; no patient or surgical involvement.The polyaxial head placement tool (03.632.037) is used in the matrix degenerative and deformity spine systems.The tool is used to retrieve a polyaxial head from an implant module and place it over a matrix bone screw.The technique guides state that, to ensure the polyaxial head is securely attached to the bone screw, the user is to gently lift up on the placement tool and angulate the polyaxial head.In order to remove the instrument from the polyaxial head the button on the proximal end of the device can be pressed.The returned instrument was examined and the complaint condition was able to be confirmed as the blocker was found to be missing from the outer shaft and was not returned.Further examination showed evidence of laser welding on the distal portion of the outer shaft.The complaint condition was unable to be replicated due to post-manufacturing damage.No definitive root cause was able to be determined.The blocker is only laser welded to half of the outer shaft body, making it vulnerable to breakage in the area of the laser weld; as such the failure mode is consistent with rough handling.Relevant drawings for the returned instrument were reviewed: top-level (03_632_037), outer shaft w/ overmold (03_632_037) and blocker (03_632_037).The design, materials and finishing processes were found to be appropriate for the intended use of these devices.The design, materials and finishing processes were found to be appropriate for the intended use of these devices.No dimensional analysis was possible due to post-manufacturing damage.A device history review, including material and hardness reviews, was performed for the returned instrument¿s lot number and no mrrs, ncrs or complaint-related issues were identified with the lot number which may have contributed to the complaint condition.Based on the investigation findings, it has been determined that no corrective and/or preventative action is proposed.Device was used for treatment, not diagnosis.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
It was reported that the button of the position-instr f/polyaxial screw heads was not functioning properly.The issue was found during an inspection of the set at the loaner department.There was no patient involvement reported.(b)(4).

• Brand Name: POSITION-INSTR F/POLYAXIAL SCREW HEADS F
• Common Device Name: MISC ORTHO SURGICAL INSTR
• Manufacturer (Section D): WRIGHTS LANE SYNTHES USA PRODUCTS LLC; 1302 wrights lane east; west chester PA 19380
• MDR Report Key: 7397135
• Report Number: 2939274-2018-51442
• Device Sequence Number: 16175056
• Product Code: LXH
• UDI-Device Identifier: 10705034718958
• UDI-Public: (01)10705034718958(10)6696065
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Health Professional
• Type of Report: Initial
• Report Date (Section B): 04/03/2018

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 Catalogue Number: 03.632.037
• Device Lot Number: 6696065
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/27/2018
• Initial Date Received by Manufacturer: 04/03/2018
• Initial Report FDA Received Date: 04/04/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1