MAUDE MDR 6574820

MDR report key
6574820
Report number
3006851902-2017-00010
Event key
0
Event type
3
Date of event
2017-04-26
Date received
2017-05-18
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MS. MELISSA LOGSDON
Address
200 DEBUSK LANE POWELL TN 37849 US
Phone
865-865-8653
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1DEROYALORTHOSIS, CERVICALDEROYAL INDUSTRIES, INC.IQK1044-31Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-05-180

Event Narratives#

N

Patient 1

THE COMPLAINT CALL STATES THAT THE "COLLAR CRACKED UNDER CHIN." THE WORK ORDER COULD NOT BE REVIEWED BECAUSE THE FINISHED GOOD LOT NUMBER WAS NOT REPORTED. QC MANAGER IN CONJUNCTION WITH MOLDING SUPERVISOR AND MOLDING TECHNICIAN EVALUATED THE PICTURES ATTACHED TO THE CALL. WHILE EVALUATING THE SECTION WHERE THE CRACKED OCCURRED, FROM MOLDING SUPERVISOR PERSPECTIVE, THIS AREA COULD BE IMPROVE BY REINFORCING IT AND ADDING MORE PLASTIC, THIS WILL GIVE MORE STRENGTH AND ROBUSTNESS TO THIS AREA. PPF0302C MOLDING WILL BE SENT TO THE RESPONSIBLE PERSONNEL TO MAKE THE NECESSARY IMPROVEMENTS. A CORRECTIVE AND PREVENTIVE ACTION REPORT ((B)(4)) INVESTIGATION WAS PERFORMED FOR SIMILAR COMPLAINTS IN 2015. AS A RESULT, THE POLYPROPYLENE (PP) RESIN RAW MATERIAL WAS CHANGED TO IMPROVE THE ELASTICITY OF THIS PART. THE FIRST LOT OF THIS PRODUCT THAT INCORPORATED MOLDED PIECES WITH THIS NEW POLYPROPYLENE RESIN WAS MANUFACTURED ON 01/27/2016 (LOT 41545015). IT WAS CONFIRMED THAT THE WORK ORDER PROVIDED WITHIN THE CALL WAS MANUFACTURED AFTER THE IMPROVEMENT. ALTHOUGH THE BREAKAGES ARE OCCURRING, THE AMOUNTS OF COMPLAINTS RECEIVED DUE TO THIS CONDITION HAVE BEEN REDUCED. AS OF 05/9/2017, ONLY 5 COMPLAINTS THAT CALL FOR THIS TYPE OF FAILURE HAS BEEN RECEIVED, FOR PRODUCT MANUFACTURED AFTER THE PREVIOUS CORRECTIVE ACTION, WAS IMPLEMENTED. ALTHOUGH, AT THIS TIME, A DEFINITIVE ROOT CAUSE COULD NOT BE DETERMINED AFTER EXAMINING ALL AVAILABLE INFORMATION (FINISHED GOOD WORK ORDER, SUB-ASSEMBLY AND MOLDING SET UP SHEET). WITH THE CONCLUSION ABOUT THE MEETING HELD WITH MOLDING SUPERVISOR AND HIS INPUTS ABOUT THE CRACKING ISSUE, A POTENTIAL ROOT CAUSE COULD BE BASED ON PIECE DESIGN AND HIS EXPERIENCE, THIS SECTION COULD ALLOW A WEAKNESS THAT MAY LEAD TO THE WHOLE MIDDLE SECTION CRACKING. AS CORRECTIVE ACTION ANOTHER IMPROVEMENT WILL BE MADE TO THE MOLD BY ADDING MORE PLASTIC TO THE MIDDLE SECTION. THIS WILL GIVE MORE STRENGTH AND ROBUSTNESS TO THIS AREA. THE PLANNED COMPLETION DATES FOR THIS IMPROVEMENT, TO BE MADE TO THE MOLD, IS SET TO THE 16/JUN/2017. BETWEEN, JANUARY 1, 2015 - MAY 17, 2017, THERE HAVE BEEN A TOTAL OF 23 COLLARS REPORTED TO BE MALFUNCTIONING AND (B)(4) UNITS SOLD, OF THIS PRODUCT 1044-31 CERVICAL COLLAR, EMT SELECT. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME. WE WILL PROVIDE A FOLLOW UP REPORT IF ADDITIONAL INFORMATION BECOMES AVAILABLE.

D

Patient 1

WHEN DID QUALITY ISSUE OCCUR? BEFORE USE. WHO WAS USING OR OPERATING THE PRODUCT WHEN THE QUALITY ISSUE OCCURRED? HEALTH PROFESSIONAL. WAS A MEDICAL PROCEDURE INVOLVED? NO. NAME OF MEDICAL PROCEDURE: NOT APPLICABLE. DID THE QUALITY ISSUE CAUSE A DELAY IN THE MEDICAL PROCEDURE? NOT APPLICABLE. DETAILED DESCRIPTION OF QUALITY ISSUE: COLLAR CRACKED UNDER CHIN. HOW WAS THE QUALITY ISSUE WAS IDENTIFIED? BY VISUAL INSPECTION. HOW WAS THE PRODUCT BEING USED? SPINAL PRECAUTION. WAS IT THE INITIAL USE OF THE PRODUCT? YES. WAS THE PRODUCT MODIFIED FROM THE ORIGINAL CONDITION SUPPLIED BY DEROYAL? NO. WAS THE PRODUCT CONNECTED TO OR USED IN CONJUNCTION WITH OTHER DEVICES OR EQUIPMENT? NO. *** OUTCOME DETAILS *** OUTCOME(S) ATTRIBUTED TO QUALITY ISSUE: NONE. PERSON(S) AFFECTED BY OUTCOME(S) CHECKED ABOVE: NONE. KNOWN PRE-EXISTING CONDITION(S) OF PERSON(S) AFFECTED: NONE SPECIFIED. WAS THE INCIDENT REPORTED TO THE FDA? NO. DETAILED DESCRIPTION OF OUTCOME(S), INCLUDING INFORMATION REGARDING INJURY OR ANY ADDITIONAL TREATMENT/INTERVENTION REQUIRED: NONE.