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Model Number 10-17-0001
Device Problem Mechanical Problem (1384)
Patient Problems Failure of Implant (1924); Device Embedded In Tissue or Plaque (3165)
Event Type  malfunction  
Manufacturer Narrative
During the review of the dhr for lot br37528g, it was concluded that the product was inspected and accepted for use by the quality control department on 2/12/19 and met all specified parameters of the receiving inspection report with no associated nonconformance specific to the product issue. No similar complaints for 10-17-0001 locking screw assembly of post operative implant disassociated have been received in the last 24 months. Trend review indicates no adverse trend exists for the fault type. The severity of interbody implant breaks, loosens or experiences excess movement post-operatively has been identified as moderate (ha-0004b, 12. 1. 1). The revision surgery was successfully completed using an alternative 10-17-0001 locking screw assembly. Patient current condition is asymptomatic with no further plans to revise at this time. No capa will be initiated at this time because there is no evidence to suggest a manufacturing or design defect occurred. Review of labeling: contraindications any medical or surgical condition which would preclude the potential benefit of spinal implant surgery is a contraindication. The following conditions may reduce the chance of a successful outcome and should be taken into consideration by the surgeon. This list is not exhaustive: absolute contraindications: infection in or around the operative site, allergy or sensitivity to implant materials, any case not described in the indication. Relative contraindications: local inflammation, morbid obesity, pregnancy, fever or leukocytosis, prior fusion at the level(s) to be treated, grossly distorted anatomy due to congenital abnormalities, rapid joint disease, bone absorption, osteopenia, and/or osteoporosis, elevation of sedimentation rate unexplained by other diseases, elevation of white blood count (wbc), or a marked left shift in the wbc, differential count, any case not requiring bone graft and fusion or where fracture healing is not required, patients having inadequate tissue coverage over the operative site or where there is inadequate bone stock, bone quality, or anatomical definition unsuitable or insufficient bone support, bone immaturity, the patient's activity level, mental condition, occupation and/or a patient unwilling to cooperate with the postoperative instructions, any case where implant utilization would interfere with anatomical structures or expected physiological performance, use of components and/or incompatible materials from other systems. Possible adverse events: like other spinal system implants, the following adverse events are possible. This list is not exhaustive: delayed union or nonunion (pseudarthrosis), bending, disassembly or fracture of implant and components. Loosening of spinal fixation implants may occur due to inadequate initial fixation, latent infection, and/or premature loading, possibly resulting in bone erosion, migration or pain. Pain, discomfort, or abnormal sensations due to the presence of the device. Pressure on skin where inadequate tissue coverage exists over the implant, with potential extrusion through the skin. Dural leak requiring surgical repair. Cessation of growth of the fused portion of the spine. Subsidence of the implant into adjacent bone. Loss of proper spinal curvature, correction, height and/or reduction. Increased biomechanical stress on adjacent levels. Improper surgical placement of the implant causing stress shielding of the graft or fusion mass. Intraoperative fissure, fracture, or perforation of the spine. Postoperative fracture due to trauma, defects, or poor bone stock. Serious complications associated with any surgery may occur. These include, but are not limited to: wound complications, infection, genitourinary disorders, gastrointestinal disorders, vascular disorders, including thrombus; bronchopulmonary disorders, including emboli; bursitis, hemorrhage, myocardial infarction, paralysis or death. Warnings and precautions patients with previous spinal surgery at the level(s) to be treated may have different clinical outcomes compared to those without previous surgery. The safety and effectiveness of spinal systems have been established only for spinal conditions with significant mechanical instability or deformity requiring fusion with instrumentation. These conditions are significant mechanical instability or deformity of the spine secondary to severe spondylolisthesis, degenerative spondylolisthesis with objective evidence of neurological impairment, fracture, dislocation, scoliosis, kyphosis, spinal tumor and failed previous fusion (pseudarthrosis). The safety and effectiveness of these devices for any other condition is unknown. The implantation of this system should be performed only by experienced spinal surgeons with specific training in the use of this device because this is a technically demanding procedure presenting a risk of serious injury to the patient. Based on the fatigue testing results, the surgeon should consider the levels of implantation, patient weight, patient activity level, other patient conditions, etc. Which may impact the performance of the system ensure all implants, components or instruments are sterilized prior surgery. The use of non-sterile devices may lead to inflammation, infection or disease. Implants should never be reused under any circumstances. A used implant should be discarded. While the implant may appear undamaged, it may have small defects or internal stress patterns and if implanted, could fail to perform as intended and pose safety risks to the patient. The risks include, but are not limited to, mechanical failure, breakage, difficulty with implantation, incompatibility with mating components and infection.
Event Description
On (b)(6) 2019, a revision surgery took place due to the loosening of quantity (1) coral locking screw assembly from a prior surgery (original surgery date unknown). The revision was completed successfully by replacing the locking screw assembly. The patient is healing well as expected and there are no further plans to revise at this time. No radiographs have been provided for review, and the product has not been received by the manufacture for analysis at this time.
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Brand NameCORAL
Manufacturer (Section D)
5770 armada drive
carlsbad CA 92008
Manufacturer Contact
audrey mudderman
5770 armada drive
carlsbad, CA 92008
MDR Report Key9499243
MDR Text Key195433072
Report Number3012120772-2019-00035
Device Sequence Number1
Product Code NKB
Combination Product (y/n)N
Reporter Country CodeSP
PMA/PMN Number
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type distributor
Reporter Occupation Administrator/Supervisor
Type of Report Initial
Report Date 12/19/2019
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received12/19/2019
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator
Device Model Number10-17-0001
Device Catalogue Number10-17-0001
Device Lot Number10-17-0001
Was Device Available for Evaluation? No
Is the Reporter a Health Professional?
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received11/25/2019
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient Treatment Data
Date Received: 12/19/2019 Patient Sequence Number: 1