inforMED
MalfunctionJDN

RAPHAEL

Received Mar 8, 2023 · Event occurred Feb 9, 2023

Report 3009051471-2023-00004 · MDR key 16501416

Device

Generic name

Set Screw

Model number

015.1010

Product problems

  • Material Separation
  • Material Separation

Patient

Unknown

  • No Clinical Signs, Symptoms or Conditions
  • No Clinical Signs, Symptoms or Conditions

Narrative

Description of Event or Problem

PATIENT WAS VISITING OFFICE FOR FOLLOW UP AFTER A RECENT FALL. SUBJECT CONTRUCT WAS IMPLANTED/BUILT ON DATE OF (B)(6) 2022. 7-MONTH POST OPERATION X-RAY IMAGES HAVE SHOWN THAT THE PEDICLE HOUSING SET SCREW HAS SEPARATED FROM THE PEDICLE SCREW HOUSING. NO SERIOUS INJURY NOR HARM TO THE PATIENT HAS BEEN REPORTED AS OF THE DATE OF COMMUNICATION. ATTEMPTS HAVE BEEN MADE TO EXTRACT MORE INFORMATION REGARDING SURGICAL/FALL INCIDENT, BUT NO FURTHER INFORMATION FROM THE FIELD/REPRESENTATIVES HAVE BEEN PROVIDED. WITHOUT FURTHER INFORMATION, THE COMPANY DOES NOT KNOW IF FUSION HAD OCCURRED WITHIN THE PAST 6 MONTHS. WITHOUT FURTHER INFORMATION, THE CASE IS DEEMED TO BE INDETERMINATE.