inforMED
MalfunctionFMP

SHOULDER TOWER SUSPENSION SYSTEM

Received Dec 22, 2016 · Event occurred Nov 22, 2016

Report 1221538-2016-00003 · MDR key 6199277

Device

Generic name

Shoulder Tower

Model number

AR-1650-01

Product problems

  • Detachment Of Device Component
  • Detachment Of Device Component

Patient

Not reported

  • No Known Impact Or Consequence To Patient
  • No Known Impact Or Consequence To Patient

Narrative

Additional Manufacturer Narrative

AWAITING THE RETURN OF THE DEVICE FOR ROOT CAUSE EVALUATION, REMEDIATION DETERMINATION AND IMPLEMENTATION. A FOLLOW-UP MDR WILL BE FILED.

Description of Event or Problem

FAIRLY EARLY IN THE CASE. PRIOR TO ANCHOR PLACEMENT. THEY TRIED TO ADJUST INTERNAL/EXTERNAL ROTATION SEVERAL TIMES. THE RIVETED SCREW ON THE BOOM FELL OUT AND INTO THE STERILE FIELD. THERE WAS NO KNOWN INJURY/ADVERSE EVENT TO THE PATIENT DUE TO THIS INCIDENT.