MAUDE MDR 9539938

MDR report key
9539938
Report number
3007700286-2019-00151
Event key
0
Event type
3
Date of event
2019-12-09
Date received
2020-01-02
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
W. RECKLING, M.D.
Address
471 EL CAMINO REAL SUITE 101 SANTA CLARA CA 95050 US
Phone
408-408-4082
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1IFUSE IMPLANT SYSTEMORTHOPEDIC RODSI-BONE, INC.OURSEE SECTION H.10SEE SECTION H.10R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-01-0201. O

Event Narratives#

N

Patient 1

BASED ON THE INFORMATION PROVIDED, REVIEW OF THE SURGICAL TECHNIQUE MANUAL, IFU, CERTIFICATES OF ANALYSIS AND FMEAS, THERE IS NO INDICATION OF DEVICE FAILURE AND NO INDICATION THAT THE DEVICE WAS OUT OF SPECIFICATION. THE MOST PROBABLE ROOT CAUSE COULD NOT BE DETERMINED. IT WAS THE SURGEON'S DECISION TO REMOVE THE IMPLANT AT THE PATIENT'S REQUEST. PART NUMBERS, LOT NUMBERS, EXPIRATION DATES AND UDI/GTIN NUMBERS: 1ST (SUPERIOR): IFUSE-3D IMPLANT, P/N 7090M-90, LOT# 9010161, MFD. 05/14/19, EXP. 2024-05-14, GTIN (B)(4). 3RD (INFERIOR): IFUSE-3D IMPLANT, P/N 7065M-90, LOT# 2661651, MFD. 12/18/18, EXP. 2024-12-18, GTIN (B)(4).

D

Patient 1

THE PATIENT HAD RIGHT SIDE SI JOINT ARTHRODESIS IN (B)(6) 2019 WHERE THREE IMPLANTS WERE INSTALLED. THE PATIENT LATER REPORTED NO PAIN RELIEF AND REQUESTED THAT THE IMPLANTS BE SHORTENED. THE SURGEON CONFIRMED VIA CT SCANS THAT THE IMPLANTS WERE PROPERLY POSITIONED BUT DECIDED TO REMOVE AND REPLACE THE IMPLANTS WITH SHORTER IMPLANTS AT THE PATIENT'S REQUEST. IN (B)(6) 2019, THE SURGEON PERFORMED A REVISION PROCEDURE WHERE HE REMOVED THE INFERIOR POSITIONED IMPLANT AND REPLACED IT WITH A SHORTER IMPLANT OF THE SAME TYPE. HE THEN REMOVED THE SUPERIOR POSITIONED IMPLANT USING THE CHISELS AS IT WAS SOLIDLY FIXED IN BONE AND REPLACED IT WITH A SHORTER IMPLANT OF THE SAME TYPE. THE PREEXISTING MIDDLE IMPLANT WAS NOT ADJUSTED OR REMOVED. THE STATUS OF THE PATIENT FOLLOWING THE REVISION PROCEDURE IS NOT KNOWN.