FDA Adverse Event Malfunction Summary report: N

1723170-2015-00375

MDR report key: 4639178 · Received March 27, 2015

Report

Report Number
1723170-2015-00375
Event Type
Malfunction
Date Received
March 27, 2015
Date of Event
February 27, 2015
Report Date
February 23, 2016
PMA / PMN Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CO, US
Reporter Occupation
MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

Narratives

Additional Manufacturer Narrative · 1

CORRECTION TO LOT # AND PART NUMBER. ACTUAL PART RECEIVED: INSTRUMENT 9339082 MOD QC RATCHET HNDL. LOT # PR05L008.

Additional Manufacturer Narrative · 1

FURTHER REVIEW OF THE PART NUMBER, AND LOT NUMBER, OF THE RETURNED DEVICE FOUND THAT THE DEVICE WAS MANUFACTURED BY A DIFFERENT MEDTRONIC FACILITY. THE COMPLAINT WAS FORWARDED TO THE FACILITY FOR INVESTIGATION. AS THE DEVICE WAS A NOT MANUFACTURED BY MEDTRONIC NAVIGATION, INC., THIS ISSUE WILL NOT BE DOCUMENTED IN A MEDTRONIC NAVIGATION HARDWARE ANOMALY TRACKING DATABASE.

Additional Manufacturer Narrative · 1

CORRECTION: IT WAS DISCOVERED ON 27-JAN-2016, THAT AN INCORRECT DATE WAS REFERENCED IN A PREVIOUS SUPPLEMENTAL 3500A SUBMISSION. THE REPORTED DATE OF 16-AUG-2016 WAS REPORTED INCORRECTLY AND SHOULD BE 16-AUG-2015.STATEMENT IN PREVIOUS SUPPLEMENTAL 3500A SUBMISSION SHOULD READ: ¿ON 30-JUN-2015, IT WAS NOTICED THAT A CODING ERROR IN MDR SUBMISSIONS FROM OUR FACILITY RESULTED IN THE MAUDE DATABASE INCORRECTLY CODING THE DEVICES RELATED TO OUR MDR SUBMISSIONS FROM 25-MAY-2015 TO 16-AUG-2015. THE DECISION TO WAIT UNTIL THE DATABASE WAS CORRECTED WAS MADE AFTER CONSULTATION WITH THE FDA AS ADVISED BY A CONSUMER SAFETY OFFICER WITH THE INFORMATION ANALYSIS BRANCH, DIVISION OF POST MARKET SURVEILLANCE, OFFICE OF SURVEILLANCE AND BIOMETRICS. AN IT SOLUTION WAS IMPLEMENTED ON 16-AUG-2015. THIS MDR WAS SUBMITTED TO CORRECT THE CODING ERROR. THERE IS NO NEW INFORMATION TO CHANGE THE PATIENT INFORMATION, EVENT DESCRIPTION AND/OR MANUFACTURER NARRATIVE THAT WAS PREVIOUSLY REPORTED.¿

Additional Manufacturer Narrative · 1

PATIENT INFORMATION WAS NOT MADE AVAILABLE FROM THE SITE. PRODUCT IS CLASS I FOR US REGULATIONS AND DOES NOT REQUIRE A 510(K) DESIGNATION. DEVICE MANUFACTURING DATE IS UNAVAILABLE. RETURN REQUESTED. NO PARTS HAVE BEEN RECEIVED BY MANUFACTURER FOR ANALYSIS. (B)(4) 2015 - A MEDTRONIC REPRESENTATIVE, FOLLOWING-UP AT THE SITE, REPORTED A LOCAL MEDTRONIC REPRESENTATIVE PROVIDED A SMALLER GRAY EGG-SHAPED HANDLE TO THE SITE AND RECOMMENDED THEY USE IT INSTEAD OF THE RATCHETING HANDLE THEY HAD BEEN USING. THERE HAVE BEEN NO REPORTED ISSUES WITH USING THIS NEW HANDLE DESIGN. THE MEDTRONIC REPRESENTATIVES WERE NOT ALLOWED TO REMOVE THE SUSPECT HANDLE FROM THE SITE. (B)(4).

Additional Manufacturer Narrative · 1

ANALYSIS OF SUSPECT INSTRUMENT AS FOLLOWS: UNABLE TO DETERMINE THE AGE OF THE HANDLE BUT IT APPEARS TO BE WELL WORN. AS REPORTED, THE RATCHETING MECHANISM HAS BROKEN LOOSE AND IS NO LONGER FUNCTIONAL. OTHERWISE, THE HANDLE RECEIVES INSTRUMENTS WITHOUT ISSUE. THE END CAP IS STILL INTACT. THIS ISSUE WILL BE TRENDED AND MONITORED IN A MEDTRONIC HARDWARE ANOMALY TRACKING DATABASE. A REPLACEMENT INSTRUMENT WAS SENT TO THE SITE FOR ISSUE RESOLUTION.

Description of Event or Problem · 1

A MEDTRONIC REPRESENTATIVE REPORTED THAT, WHILE IN A SPINAL FUSION PROCEDURE, WHEN THE SURGEON WAS MALLETING THE BACK OF THE RATCHETING HANDLE, THE HANDLE WAS STARTING TO BREAK. THE SITE SAW THE INSTRUMENT WAS ABOUT TO BREAK AND STOPPED USE OF THAT HANDLE. A SECOND HANDLE WAS BROUGHT IN AND USED TO CONTINUE THE PROCEDURE WITH NO DELAY. THE SURGEON COMPLETED THE PROCEDURE WITH THE USE OF THE NAVIGATION SYSTEM. THERE WAS NO IMPACT ON PATIENT OUTCOME.

Patients

Seq Age Sex Outcome Treatment
1