FDA Adverse Event Malfunction Summary report: N

MAYFIELD 2000 SKULL CLAMP

MDR report key: 10279593 · Received July 15, 2020

Report

Report Number
3004608878-2020-00171
Event Type
Malfunction
Date Received
July 15, 2020
Date of Event
March 20, 2020
Report Date
March 20, 2020
Manufacturer
INTEGRA LIFESCIENCES CORPORATION OH/USA
Product Code
HBL
PMA / PMN Number
K932807
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

ADDITIONAL INFORMATION: D10, G4, G7, H2, H3, H6, H10 UDI # (B)(4) THE DEVICE WAS RETURNED TO THE MANUFACTURER FOR EVALUATION. THE RETURNED UNIT RECEIVED WITH THE HEX BRUSHING WORN, THE LOCK STILL MOVED AFTER THE UNIT WAS LOCKED DOWN AND NEEDED TO BE REPLACED. THE PROVIDED SERIAL NUMBER (B)(6) DOES NOT APPEAR TO BE A VALID INTEGRA NUMBER. THE REPORTED COMPLAINT WAS CONFIRMED AS THE RETURNED UNIT DID NOT MEET ALL SPECIFIC FUNCTIONAL TESTS. BETWEEN 05NOV2019 AND 30JUN2020, APPROXIMATELY 2,200 MDRS SUBMITTED ELECTRONICALLY BY INTEGRA LIFESCIENCES VIA TRACKWISE, INTEGRA'S COMPLAINT HANDLING SYSTEM, WERE NOT RECEIVED BY CDRH DUE TO A COMPUTER SYSTEM ISSUE. WITHIN THIS TIME PERIOD, AN ERROR WITH INTEGRA'S MIDDLEWARE, WHICH FACILITATES COMMUNICATIONS BETWEEN TRACKWISE AND THE FDA SYSTEM, CAUSED THE COMPLAINT RECORDS TO CLOSE AND INDICATE WE HAD RECEIVED AN ACKNOWLEDGEMENT 3 FROM THE FDA WHEN WE HAD NOT. INTEGRA INTERPRETED THE ACKNOWLEDGEMENT AS A SUCCESSFUL SUBMISSION; HOWEVER, SUBSEQUENT INVESTIGATION REVEALED THE ACKNOWLEDGEMENT 3 RECEIVED WAS FROM OUR MIDDLEWARE AND NOT FROM THE FDA (THESE ACKNOWLEDGEMENTS HAVE BEEN RETAINED AS PART OF THE DOCUMENTATION OF THE MDR). THE MALFUNCTION WAS RELATED TO THE RELOCATION OF THE TRACKWISE APPLICATION TO A NEW DATA CENTER DURING THE TRANSITION OF INTEGRA'S CORPORATE HEADQUARTERS FROM PLAINSBORO, NJ TO PRINCETON, NJ. PREVIOUSLY, INTEGRA HAD BEEN SUCCESSFULLY RECEIVING ACKNOWLEDGEMENTS 1, 2, AND 3 FROM THE FDA, AND OUR RECORDS REFLECT THESE ACKNOWLEDGEMENTS, INCLUDING THE DATE AND TIME STAMPS. CAPA PR 229048 AND NC 20-011 HAVE BEEN OPENED BY INTEGRA TO FURTHER INVESTIGATE THE NONCONFORMANCE AND DEVELOP A CORRECTIVE ACTION PLAN. THE MIDDLEWARE ERROR HAS BEEN CORRECTED, AND INTEGRA HAS FILED MDRS SINCE THE CORRECTION AND VERIFIED THAT THE APPROPRIATE ACKNOWLEDGEMENTS HAVE BEEN RECEIVED FROM THE FDA. INTEGRA IS RESUBMITTING ALL IMPACTED MDR REPORTS FOR THE TIME PERIOD 05NOV2019 THROUGH 30JUN2020. INTEGRA LIFESCIENCES CONTACTED (B)(4) OFFICE OF PRODUCT EVALUATION AND QUALITY ON JULY 8-9, 2020 TO REPORT THESE ISSUES REGARDING MDR REPORTS.

Additional Manufacturer Narrative · 1

THE DEVICE WAS NOT YET RECEIVED BY THE MANUFACTURER FOR EVALUATION. THE PLANT INVESTIGATION IS IN PROGRESS AND A SUPPLEMENTAL MEDWATCH REPORT WILL BE SUBMITTED UPON COMPLETION OF THE INVESTIGATION.

Description of Event or Problem · 1

A SALES ASSOCIATE REPORTED ON BEHALF OF THE CUSTOMER THAT THE ROCKER ARM OF THE A2000 MAYFIELD 2000 SKULL CLAMP WAS LOOSE WHEN THE SYSTEM WAS LOCKED. IT WAS DISCOVERED BEFORE SURGERY ON (B)(6) 2020. THERE WAS NO PATIENT INJURY NOR DELAY IN SURGERY REPORTED. ANOTHER SKULL CLAMP WAS TAKEN TO PERFORM THE SURGERY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
740602 MAYFIELD 2000 SKULL CLAMP SKULL CLAMPS AND HEADREST SYSTEMS HBL INTEGRA LIFESCIENCES CORPORATION OH/USA

Patients

Seq Age Sex Outcome Treatment
1