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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ORTHOPEDIATRICS, INC PEDILOC 4.5MM LOCKING CORTICAL SCREW SIZE 48MM

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ORTHOPEDIATRICS, INC PEDILOC 4.5MM LOCKING CORTICAL SCREW SIZE 48MM Back to Search Results
Catalog Number 00-1050-4648
Device Problem Migration (4003)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Date 01/25/2019
Event Type  Injury  
Manufacturer Narrative
(b)(4).Concomitant device: item number: 00-1050-4206, 4.5 mm contour locking compression femur 6 hole plate right, lot number: 18218-o; item number: 00-1050-4665, 4.5mm locking cortical screw size 65mm, lot number: 88732; item number: 00-1050-4665, 4.5mm locking cortical screw size 65mm, lot number: i01rp; item number: 00-1050-4640, 4.5mm locking cortical screw size 40mm, lot number: i0rc; item number: 00-1050-4660, 4.5mm locking cortical screw size 60mm, lot number: i06g8-e; item number: 00-1050-4638, 4.5mm locking cortical screw size 38mm, lot number: 79229-e.X-rays were provided and confirmed the reported malfunction.A visual analysis of the returned device found damaged threads on the shaft body of the screws and plate.This finding does not contribute to the cause of the event as it likely occurred post screw back out.A review of the dhrs were reviewed and no discrepancies were found.Review of the complaint history determined that no further action is required as no trends were identified.Root cause was unable to be determined.Multiple mdr reports were filed for this event, please see associated reports: 3006460162-2020-00008, 3006460162-2020- 000009, 3006460162-2020-000011, 3006460162-2020-000012 and 3006460162-2020-000013.
 
Event Description
It has been reported that following the implantation of a distal femoral osteotomy system, the screws were found to be dissociated.
 
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Brand Name
PEDILOC 4.5MM LOCKING CORTICAL SCREW SIZE 48MM
Type of Device
SCREW
Manufacturer (Section D)
ORTHOPEDIATRICS, INC
2850 frontier drive
warsaw IN 46582
Manufacturer (Section G)
ORTHOPEDIATRICS
2850 frontier drive
warsaw IN 46582
Manufacturer Contact
leigh jessop
2850 frontier drive
warsaw, IN 46582
MDR Report Key9654232
MDR Text Key177411255
Report Number3006460162-2020-00010
Device Sequence Number1
Product Code HWC
Combination Product (y/n)N
Reporter Country CodeGM
PMA/PMN Number
K083286
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type distributor,foreign,health pr
Reporter Occupation Physician
Type of Report Initial
Report Date 01/31/2020
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? Yes
Device Operator Health Professional
Device Catalogue Number00-1050-4648
Device Lot Number77993-E
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer01/07/2020
Is the Reporter a Health Professional? Yes
Initial Date Manufacturer Received 01/07/2020
Initial Date FDA Received01/31/2020
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured03/29/2017
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Patient Age22 YR
Patient Weight95
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