MAUDE MDR 9660141

MDR report key
9660141
Report number
1526439-2020-00485
Event key
0
Event type
3
Date of event
2019-12-09
Date received
2020-02-03
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
100
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
KARA DITTY-BOVARD
Address
325 PARAMOUNT DRIVE RAYNHAM MA 02767 US
Phone
610-610-6103
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1POLY SCREW DRIVER RETEN SLEEVECANNULA, SURGICAL, GENERAL & PLASTIC SURGERYMEDOS INTERNATIONAL SàRL CHGEA2020-00-401202000401PC4907029Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-02-030

Event Narratives#

N

Patient 1

IF THE INFORMATION IS UNKNOWN, NOT AVAILABLE OR DOES NOT APPLY, THE SECTION/FIELD OF THE FORM IS LEFT BLANK. A PRODUCT INVESTIGATION WAS CONDUCTED. VISUAL ANALYSIS: THE PACKAGE FOR PC-#000617179 FOR PART NUMBERS 2020-33-400 AND 2020-00-401 WITH LOT NUMBERS PC4585369 AND PC4907029 RESPECTIVELY WERE RETURNED FOR EVALUATION AND EXAMINED BY THE QUALITY ENGINEER. PART NUMBER 2020-00-401 (RETENTION SLEEVE) WAS FOUND TO HAVE SIGNS OF NORMAL USE. PART NUMBER 2020-33-400 (X20 POLYDRIVER) WAS FOUND TO HAVE SIGNS OF WEAR IN THE PROXIMAL ANNULAR GROOVE FEATURE. ADDITIONALLY, THE POLYDRIVER WAS FOUND TO HAVE EXCESSIVE DEBRIS NEAR THE PROXIMAL GROOVE AND ALONG THE OUTER SURFACE OF THE SHAFT. FUNCTIONAL ANALYSIS: DURING THE FUNCTIONAL ANALYSIS OF THE X20 POLYDRIVER/RETENTION SLEEVE, IT WAS NOTED THAT THE INSTRUMENTS DID NOT FUNCTION PROPERLY. ROTATION AND AXIAL MOTION WERE LOCKED. THE X20 SHAFT WAS NOT ABLE TO BE REMOVED FROM THE RETENTION SLEEVE. TECHNICAL REVIEW: REVIEWING THE TOLERANCE ANALYSIS, IT WAS FOUND THAT WHEN ATTACHING THE RETENTION SLEEVE/X20 POLYDRIVER ASSEMBLY TO A POLY SCREW AND TIGHTENING, THE INTERNAL BALL BEARINGS OF THE RETENTION SLEEVE MAKES CONTACT WITH THE SURFACE OF THE GROOVE NOTED ABOVE. DOCUMENT/SPECIFICATION REVIEW: BASED ON THE DATE OF MANUFACTURE THE RELEVANT DRAWINGS, REFLECTING THE CURRENT AND MANUFACTURED REVISION WERE REVIEWED INVESTIGATION CONCLUSION: THE COMPLAINT CONDITION IS CONFIRMED FOR THE POLY SCREWDRIVER RETEN SLEEVE (P/N: 202000401, LOT # PC4907029) AS THE X20 POLYDRIVER THE POLYDRIVER WAS FOUND TO HAVE EXCESSIVE DEBRIS NEAR THE PROXIMAL GROOVE AND ALONG THE OUTER SURFACE OF THE SHAFT, WHICH COULD HAVE CONTRIBUTED TO THE COMPLAINT CONDITION. THERE IS NO INDICATION THAT A DESIGN OR MANUFACTURING ISSUE HAS CAUSED THE ISSUE AND HENCE THE ROOT CAUSE CANNOT BE DETERMINED. BASED ON THE INVESTIGATION FINDINGS, IT HAS BEEN DETERMINED THAT NO CORRECTIVE AND/OR PREVENTATIVE ACTION IS PROPOSED. ADDITIONAL MONITORING FOR ANY POTENTIAL SAFETY SIGNALS WILL BE CONDUCTED THROUGH COMPLAINT TRENDING AND OTHER POST-MARKET SAFETY SURVEILLANCE ACTIVITIES. UPON ADDITIONAL TORQUE BEING APPLIED TO THE RETENTION SLEEVE, ADDITIONAL FORCE IS APPLIED FROM THE BALL BEARINGS TO THE GROOVE SURFACE, ROLLING THE EDGE OF THE GROOVE AND CREATING A METALLIC BURR. THIS BURR HINDERS THE INSERTION AND REMOVAL OF THE X20 POLYDRIVER FROM THE RETENTION SLEEVE, CREATING DRAG. A DEVICE HISTORY RECORD (DHR) REVIEW WAS CONDUCTED: A REVIEW OF THE RECEIVING INSPECTION (RI) FOR POLY SCREW DRIVER RETEN SLEEVE WAS CONDUCTED IDENTIFYING THAT LOT NUMBER PC4907029 WAS RELEASED IN A SINGLE BATCH. BATCH1: LOT QTY OF 49 UNITS WERE RELEASED ON 31 OCT 2019 WITH NO DISCREPANCIES. AS A RESULT, THE RI IDENTIFIED NO ISSUES DURING THE MANUFACTURING AND RELEASE OF THIS DEVICE THAT COULD HAVE CONTRIBUTED TO THE PROBLEM REPORTED BY THE CUSTOMER. THE RI IDENTIFIED NO ISSUES DURING THE MANUFACTURING AND RELEASE OF THIS DEVICE THAT COULD HAVE CONTRIBUTED TO THE PROBLEM REPORTED BY THE CUSTOMER. 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 ON (B)(6) 2019, DURING C2-T2 POSTERIOR CERVICAL FUSION THE SURGEON COMPLETED THE SURGERY WITH DEPUY SYNTHE SPINE SYMPHONY IMPLANTS. WHEN THE SCRUB TECH WAS DISASSEMBLING THE INSTRUMENTS AFTER THE SURGERY WAS SUCCESSFULLY COMPLETED, SHE COULD NOT GET THE X20 POLY SCREWDRIVER SHAFT TO COME APART FROM THE RETENTION SLEEVE. THESE 2 PIECES ARE STUCK TOGETHER. THE X20 POLY SCREWDRIVER SHAFT THAT IS DEFORMING DOES NOT SLIDE DOWN THE RETENTION SLEEVE. THE SURGEON DID USE 4.5MM DIAMETER SCREWS IN T1 AND T2 AND THE INSERTIONAL TORQUE WAS FAIRLY HIGH. THERE WERE NO PATIENT CONSEQUENCES. THERE WAS NO SURGICAL DELAY. NO FRAGMENTS GENERATED. THE PROCEDURE WAS SUCCESSFULLY COMPLETED. THIS IS REPORT 1 OF 1 FOR COMPLAINT (B)(4).