MAUDE MDR 6977258

MDR report key
6977258
Report number
3009383407-2017-00002
Event key
0
Event type
3
Date received
2017-10-25
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 VICKI CLOUTIER
Address
4025 WELCOM ALL ROAD SUITE 120 ATLANTA GA 30349 US
Phone
951-951-9513
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1OMNIPORE SURGICAL IMPLANT - CRANIOTOMY GAP WEDGECRANIOTOMY GAP WEDGEMATRIX SURGICAL USAKKYOP82011OP8201100855421005727 018141116Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-10-250

Event Narratives#

N

Patient 1

DEVICE EVALUATION: DISTRIBUTOR RETURNED DEVICES FOR EXCHANGE ON 12-OCT-2017; THE REPORTED NON-CONFORMITY WAS CONFIRMED. A REVIEW OF THE MANUFACTURING RECORDS SHOWED NO ANOMALIES. A REVIEW OF PREVIOUS COMPLAINT HISTORY SHOWS THAT NO SIMILAR COMPLAINTS HAVE BEEN REPORTED. ALL AVAILABLE DEVICES IN INVENTORY MANUFACTURED DURING THE SAME TIMEFRAME WERE VISUALLY INSPECTED FOR UNSEALED POUCHES. NO ADDITIONAL IMPACTED DEVICES WERE IDENTIFIED. POTENTIAL CONTRIBUTING MANUFACTURING FACTORS HAVE BEEN CONSIDERED AND CORRECTIVE ACTIONS HAVE BEEN INITIATED. A GOOD FAITH EFFORT WILL BE MADE TO INSPECT ALL REMAINING INVENTORY FOR THIS ISSUE PRIOR TO SHIPMENT. (B)(4).

D

Patient 1

ON SEPTEMBER 27, 2017, IT WAS REPORTED BY OUR CONTRACT DISTRIBUTOR (B)(4) IN (B)(4) THAT THE OUTER POUCH FOR PART CRANIOTOMY GAP WEDGES (OP82011); LOT 00855421005727 018141116 WAS NOT SEALED. NO PATIENT OR END USER INVOLVEMENT.