BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    OPEN SPINE CLAMP, TITANIUM

    MDR report key: 4221282 · Received November 3, 2014

    Report

    Report Number
    1723170-2014-01168
    Event Type
    Malfunction
    Date Received
    November 3, 2014
    Date of Event
    October 15, 2014
    Report Date
    November 9, 2015
    Manufacturer
    MEDTRONIC NAVIGATION, INC.
    Product Code
    HAW
    PMA / PMN Number
    K990214
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    NO PATIENT INFORMATION PROVIDED AS NO PATIENT WAS INVOLVED IN THIS CONCERN. MEDTRONIC INVESTIGATION OF RETURNED SUSPECT DEVICE FINDS THAT AS REPORTED, THE ATTACHMENT SCREW THREADS ARE STRIPPED IN THE MIDDLE OF THE TRAVEL WITH DEBRIS IN THE THREADS AS WELL. THE RETAINER RING AT THE TIP OF THE SCREW IS STRETCHED ALLOWING SOME PLAY IN THE CLAMP FACE. THE HEAD OF THE SCREW IS NORMAL. THE REPORTED EVENT WAS CONFIRMED TO BE CAUSED BY PHYSICAL DAMAGE OF THE SCREW. REPLACEMENT DEVICE SHIPPED TO SITE FOR ISSUE RESOLUTION.

    Additional Manufacturer Narrative · 1

    CORRECTION: ON 13-OCT-2015, IT WAS NOTICED THAT A PREVIOUS MDR SUBMISSION CONTAINED INCORRECT INFORMATION WITH REGARDS TO THE COMMON DEVICE NAME, PRODUCT CODE AND/OR PMA/510(K). THIS MDR IS BEING SUBMITTED TO CORRECT THIS INFORMATION. THERE IS NO NEW INFORMATION TO CHANGE THE PATIENT INFORMATION, EVENT DESCRIPTION OR MANUFACTURER NARRATIVE THAT WAS PREVIOUSLY REPORTED.

    Description of Event or Problem · 1

    A MEDTRONIC REPRESENTATIVE REPORTED THAT THE SCREW ON THE SPINE CLAMP INSTRUMENT WAS DAMAGED. NO FURTHER DETAILS REGARDING THE DAMAGE, OR HOW IT OCCURRED, WERE PROVIDED. THERE WAS NO PATIENT PRESENT WHEN THIS ISSUE WAS IDENTIFIED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    700784 OPEN SPINE CLAMP, TITANIUM NEUROLOGICAL STEREOTAXIC INSTRUMENT HAW MEDTRONIC NAVIGATION, INC. 131011

    Patients

    Seq Age Sex Outcome Treatment
    1