MAUDE MDR 6736677

MDR report key
6736677
Report number
2530088-2017-10230
Event key
0
Event type
3
Date of event
2017-06-26
Date received
2017-07-24
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
MICHAEL COTE
Address
1302 WRIGHTS LANE EAST WEST CHESTER PA 19380 US
Phone
610-610-6107
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1HOOK POSITIONERHOOK, SURGICAL, GEN & PLASTIC SURGERYSYNTHES BRANDYWINEGDG388.63388.634547325Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-07-240

Event Narratives#

N

Patient 1

(B)(6). DEVICE IS AN INSTRUMENT AND IS NOT IMPLANTED/EXPLANTED. THE DEVICE WAS RECEIVED, THE INVESTIGATION COULD NOT BE COMPLETED, AND NO CONCLUSION COULD BE DRAWN, AS PRODUCT IS ENTERING THE COMPLAINT SYSTEM. DHR REVIEW FOR PART #388.63, SYNTHES LOT #4547325. NO NCRS WERE GENERATED DURING PRODUCTION. REVIEW OF THE DEVICE HISTORY RECORD SHOWED THAT THERE WERE NO ISSUES DURING THE MANUFACTURE OF THIS PRODUCT THAT WOULD CONTRIBUTE TO THIS COMPLAINT CONDITION. RELEASE TO WAREHOUSE DATE: 26-FEB-2003. MANUFACTURED BY SYNTHES (B)(4). 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.

D

Patient 1

IT WAS REPORTED THAT THREE DEVICES MALFUNCTIONED DURING A T4-L2 SCOLIOSIS PROCEDURE ON (B)(6) 2017. DURING THE PROCEDURE, A HOOK POSITIONER HAD A CHUNK COME OUT OF THE PHENOLIC HANDLE DURING MALLETING. THE CHUNK WAS RECOVERED EASILY. LATER, A SOCKET WRENCH WITH STRAIGHT HANDLE SPLIT INTO TWO PIECES DURING MALLETING. ALL PIECES WERE RECOVERED. FINALLY, UPON FINAL TIGHTENING, THE SURGEON NOTICED THAT A TITANIUM (TI) COLLAR WITH GROOVES AT T8 LEFT WAS BROKEN TOWARD THE END OF THE PROCEDURE. THE BROKEN DEVICE WAS EASILY AND QUICKLY REMOVED AND ANOTHER COLLAR WAS IMPLANTED. THE PROCEDURE WAS COMPLETED WITH NO PATIENT HARM. CONCOMITANT DEVICES REPORTED: TITANIUM NUT 11MM WIDTH ACROSS FLATS (PART 498.003, LOT NUMBER UNKNOWN, QUANTITY 1); 5.0MM TITANIUM SIDE-OPENING SCREW 35MM (PART 498.535, LOT NUMBER UNKNOWN, QUANTITY 1); MALLET (PART NUMBER UNKNOWN, LOT NUMBER UNKNOWN, QUANTITY 1). THIS REPORT IS FOR ONE (1) HOOK POSITIONER. THIS IS REPORT 1 OF 2 FOR (B)(4).