BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VIPER X-25 FINAL TIGHE

    MDR report key: 1960348 · Received December 16, 2010

    Report

    Report Number
    1526439-2010-00187
    Event Type
    Malfunction
    Date Received
    December 16, 2010
    Date of Event
    December 1, 2010
    Manufacturer
    DEPUY SPINE INC.
    Product Code
    LXH
    PMA / PMN Number
    EXEMPT
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DRIVER WAS NOT RETURNED. THE TORQUE WRENCH WAS RETURNED AND TESTED. IT WAS FOUND THAT THE INNER MECHANISM WAS FROZEN AND NOT LIMITING TORQUE. WRENCH IS SUPPOSED TO CLICK OUT AT (B)(4). THE WRENCH WAS MANUFACTURED IN 09/2008 AND APPEARS TO HAVE SEEN MUCH USE. BREAKAGE OF THE TIP WAS CAUSED BY THE APPLICATION OF ATYPICAL FORCE BY THE USER DURING TIGHTENING. THE TORQUE WRENCH WAS NOT FUNCTIONING AS INTENDED AND DID NOT LIMIT TORQUE.

    Description of Event or Problem · 1

    SURGEON ATTEMPTED TO TIGHTEN THE SETSCREW DOWN IN A SPINAL CONSTRUCT BUT REPORTED THAT THE TORQUE HANDLE DID NOT CLICK OUT. THE DRIVER TIP SHEARED OFF INSIDE THE SETSCREW HEX DURING TIGHTENING. THE TIP COLD WELD IN THE SETSCREW AND CANNOT MIGRATE. THERE WAS NO ADVERSE PATIENT CONSEQUENCE AS A RESULT OF THIS EVENT. AS AN UNINTENDED PORTION OF THE DEVICE WAS LEFT IN VIVO AN MDR IS FILED TO DOCUMENT THIS MALFUNCTION. DEVICE 1 OF 2. SEE ALSO: 1526439-2010-00188.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VIPER X-25 FINAL TIGHE MANUAL SURGICAL INSTRUMENT LXH DEPUY SPINE INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK