FDA Adverse Event Malfunction Summary report: N

CANCELLOUSSCR Ø4 FULL-THR L16 TI

MDR report key: 3191210 · Received June 26, 2013

Report

Report Number
8030965-2013-03254
Event Type
Malfunction
Date Received
June 26, 2013
Report Date
November 21, 2011
Manufacturer
SYNTHES GMBH
Product Code
KWQ
PMA / PMN Number
K925351
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CH
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

SYNTHES IS SUBMITTING THIS REPORT AS A RESULT OF REMEDIATION ACTIVITIES RELATED TO FDA WARNING LETTER DATED FEBRUARY 2012. DEVICE(S) LISTED IN THIS REPORT IS (ARE) USED FOR TREATMENT, NOT DIAGNOSIS. ANY ADDITIONAL INFORMATION RECEIVED REGARDING THIS EVENT AFTER FILING THIS REPORT SHALL BE FILED ON A SUPPLEMENTAL MDR. ADDITIONAL INFO: DEVICE HISTORY RECORD REVIEW: THE MANUFACTURING DOCUMENTS WERE REVIEWED AND NO COMPLAINT RELATED ISSUES WERE FOUND. PLACEHOLDER.

Additional Manufacturer Narrative · 1

SYNTHES IS SUBMITTING THIS REPORT AS A RESULT OF REMEDIATION ACTIVITIES RELATED TO FDA WARNING LETTER DATED FEBRUARY 2012. DEVICE(S) LISTED IN THIS REPORT IS (ARE) USED FOR TREATMENT, NOT DIAGNOSIS. ANY ADDITIONAL INFORMATION RECEIVED REGARDING THIS EVENT AFTER FILING THIS REPORT SHALL BE FILED ON A SUPPLEMENTAL MDR. (B)(6). A REVIEW OF THE DHR FOR THIS LOT HAS BEEN REQUESTED. THE ADDITIONAL EVALUATION VISUAL INSPECTION REVEALED THAT THE SCREW WAS OUT OF SPECIFICATION, 2MM LONGER. THE INVESTIGATION OF THE COMPLAINED CANCELLOUS SCREW SHOWS THAT THE TIP ON THE THREAD DOES NOT CORRESPOND TO OUR SPECIFICATIONS. ONE CYCLE DURING THE MANUFACTURING PROCESS WAS NOT CARRIED OUT AS INTENDED.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE SCREW WAS 2MM LONGER THAN ITS STATED SPECIFICATIONS. THIS IS REPORT 1 OF 1 FOR COMPLAINT (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
290801 CANCELLOUSSCR Ø4 FULL-THR L16 TI KWQ SYNTHES GMBH 2728143

Patients

Seq Age Sex Outcome Treatment
1