MIDLINE MARKER 8MM WIDTH 250MM PDL120

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06,07 report with the FDA on 2013-03-18 for MIDLINE MARKER 8MM WIDTH 250MM PDL120 manufactured by Synthes Gmbh.

Event Text Entries

[3746473] This report is for file (b)(4).
Patient Sequence No: 1, Text Type: D, B5


[10610422] Synthes is submitting this report as a result of remediation activities related to fda warning letter dated february 2012. Device(s) listed in this report is (are) used for treatment, not diagnosis. Any additional information received regarding this event after filing this report shall be filed on a supplemental mdr. Product development event evaluation revealed that the device design for the poly removal tool, endplate holding arm, and midline marker were reviewed and found to be appropriate for their intended use. It should be noted that the devices were not returned for evaluation, so the exact failure mode cannot be determined for each instrument. The implants removed in this case were also not returned, so no attempts can be made to evaluate any matching deformation to predict how these instruments may have been used. Anterior lumbar revision surgeries are extremely demanding, especially in obtaining the necessary access exposure as the original exposure has been affected by scar tissue. In addition, this revision case was reported to involve a subsided implant, which may have also presented instrument/implant alignment challenges depending on the orientation of the subsided implant. If the access angle to the spine does not allow direct visualization of the disc space, or the implant orientation is challenging, excessive bending moments may be applied to the instruments. These applied moments could cause the pin on the endplate holding arm to bend and eventually break, or result in bending or breaking of the removal tool teeth or midline marker tip when leveraged against bone or another metallic surface (endplates). In addition, if the endplate holding arm is used solely to liberate the superior implant endplate from the vertebral body, the pins can bend or break under the application of significant moment arm. The technique guide warns against this type of leveraging with this instrument. Since the instruments were not returned for evaluation, and the exact failure mode cannot be determined in this case, possible causes of the described failure may be from excessive applied bending moments as a result of difficult access exposure alignment typical of anterior lumbar revision cases. Therefore, the complaint is deemed indeterminate.
Patient Sequence No: 1, Text Type: N, H10


[11108578] Synthes is submitting this report as a result of remediation activities related to fda warning letter dated february 2012. Device(s) listed in this report is (are) used for treatment, not diagnosis. Any additional information received regarding this event after filing this report shall be filed on a supplemental mdr.
Patient Sequence No: 1, Text Type: N, H10


[21944799] Synthes is submitting this report as a result of remediation activities related to fda warning letter dated february 2012. Device(s) listed in this report is (are) used for treatment, not diagnosis. Any additional information received regarding this event after filing this report shall be filed on a supplemental mdr. No sample was returned for evaluation. A review of the device history record did not show conditions that could have contributed to the reported event. This complaint is indeterminate from a manufacturing perspective.
Patient Sequence No: 1, Text Type: N, H10


[21984932] It was reported that during a pdl removal on (b)(6) 2012, the surgeon used the slap hammer to remove the holding arm (which was used to remove the inferior endplate) and the tab broke off of the holding arm. The broken tab was retrieved. The tip of the midline marker broke off while trying to dislodge the poly inlay from the inferior endplate. The broken tip was retrieved. Surgeon was able to remove poly inlay with same device. The teeth broke off of the poly inlay remover while trying to engage the poly inlay for removal. The broken teeth were retrieved. Surgeon used a different device to remove the inlay. The patient was not harmed. All three instruments are available for return. This is 2 of 3 reports for the same event.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number8030965-2013-10515
MDR Report Key3009929
Report Source05,06,07
Date Received2013-03-18
Date of Report2012-01-31
Date of Event2012-01-31
Date Mfgr Received2012-01-31
Device Manufacturer Date2009-05-15
Date Added to Maude2013-05-21
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactT MCCARRON
Manufacturer Street1302 WRIGHTS LANE EAST
Manufacturer CityWEST CHESTER PA 19380
Manufacturer CountryUS
Manufacturer Postal19380
Manufacturer Phone8006207025
Manufacturer G1SYNTHES GMBH
Manufacturer StreetEIMATTSTRASSE 3 CH-4436
Manufacturer CityOBERDORF
Manufacturer CountrySZ
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameMIDLINE MARKER 8MM WIDTH 250MM
Product CodeEML
Date Received2013-03-18
Catalog NumberPDL120
Lot NumberT935463
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerSYNTHES GMBH
Manufacturer AddressEIMATTSTRASSE 3 CH-4436 OBERDORF SZ


Patients

Patient NumberTreatmentOutcomeDate
10 2013-03-18

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