inforMED
MalfunctionOSH

RESPONSE SPINE 5.5, SET SCREW, SMALL

Received Feb 23, 2020

Report 3006460162-2019-00041 · MDR key 9742964

Device

Generic name

Pedicle Screw Spinal System

Model number

N/A

Catalog number

00-1003-3012

Lot number

UNKNOWN

Product problems

  • Fracture
  • Fracture

Patient

Not reported

  • No Consequences Or Impact To Patient
  • No Consequences Or Impact To Patient

Narrative

Additional Manufacturer Narrative

(B)(4). CONCOMITANT PRODUCT: ITEM: 00-1300-5028, FIXED CROSS CONNECTOR, 28MM, LOT: UNKNOWN. REPORTED EVENT WAS UNABLE TO BE CONFIRMED DUE TO LIMITED INFORMATION RECEIVED FROM THE CUSTOMER. DHR REVIEW WAS UNABLE TO BE PERFORMED AS THE LOT NUMBER OF THE DEVICE INVOLVED IN THE EVENT IS UNKNOWN. ROOT CAUSE WAS UNABLE TO BE DETERMINED.

Description of Event or Problem

IT WAS REPORTED THAT DURING THE PLACEMENT OF A RESPONSE SPINAL CONSTRUCT, A SMALL SET SCREW SHEERED OFF AND WAS LEFT IN THE PATIENT. NO ADVERSE EVENTS HAVE BEEN REPORTED AS A RESULT OF THE MALFUNCTION.