BONE PIN, 3.2MM X 110MM, STERILE 2 PACK
Report
- Report Number
- 3005985723-2018-00454
- Event Type
- Malfunction
- Date Received
- August 3, 2018
- Date of Event
- July 24, 2018
- Report Date
- October 9, 2018
- Manufacturer
- MAKO SURGICAL CORP.
- Product Code
- OLO
- UDI-DI
- 00848486018139
- PMA / PMN Number
- K112507
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TX, US
- Reporter Occupation
- OTHER
Narratives
REPORTED EVENT: AFTER THE TKA MAKO CASE WAS DONE IT WAS NOTICED THE EXTRA-INCISION BONE PIN TIPS ON THE 3.2X110 BONE PINS USED HAD BOTH BROKEN OFF INSIDE THE PATIENT BONE. WHICH WERE LEFT INSTEAD OF BEING REMOVED. THIS IS THE 2ND INCIDENT AT OUR LOCATION ANY INFORMATION WOULD BE BENEFICIAL. MPS CORRECTED SURGICAL DELAY FOR 20 MINUTES, PATIENT WAS UNDER ANESTHESIA. DEVICE EVALUATION AND RESULTS: THE PRODUCT WAS UNAVAILABLE FOR INSPECTION AS THE PRODUCT WAS NOT RETURNED. DEVICE HISTORY REVIEW: REVIEW OF THE PRODUCT HISTORY RECORDS INDICATE 2536 DEVICES WERE MANUFACTURED UNDER LOT NO W53978 AND ACCEPTED INTO FINAL STOCK ON 09/22/2017. COMPLAINT HISTORY REVIEW: A REVIEW OF COMPLAINTS IN CATSWEB AND TRACKWISE RELATED TO P/N 143080, L/N W47865 SHOWS 3 ADDITIONAL COMPLAINTS UNDER INVESTIGATION RELATED TO THE FAILURE IN THIS INVESTIGATION. THESE PRS ARE (B)(4). CONCLUSIONS: THE FAILURE MODE COULD NOT BE CONFIRMED BECAUSE THE PART WAS NOT AVAILABLE FOR EVALUATION. IF DEVICE AND/OR ADDITIONAL INFORMATION BECOME AVAILABLE, THIS INVESTIGATION WILL BE REOPENED. CORRECTIVE ACTION/PREVENTIVE ACTION: A REVIEW OF STRYKER¿S NC/CAPA DATABASE INDICATED THERE HAS BEEN ONE NC AND 2 CAPA ASSOCIATED WITH THE PRODUCT AND FAILURE MODE REPORTED IN THIS EVENT. THE NC AND CAPAS ARE NC 1470754 CAPA 1480798 CAPA 301. ONE CAPA HAS BEEN COMPLETED (CATSWEB SYSTEM IS CAPA 301) WHILE THE SECOND IS STILL OPEN (B)(4). DEVICE NOT RETURNED
AFTER THE TKA MAKO CASE WAS DONE IT WAS NOTICED THE EXTRA-INCISION BONE PIN TIPS ON THE 3.2X110 BONE PINS USED HAD BOTH BROKEN OFF INSIDE THE PATIENT BONE. WHICH WERE LEFT INSTEAD OF BEING REMOVED. THIS IS THE 2ND INCIDENT AT OUR LOCATION ANY INFORMATION WOULD BE BENEFICIAL. SURGICAL DELAY: 16-30 MINUTES.
AS PART OF NORMAL COMPLAINT FOLLOW-UP, AN EVALUATION OF THE EVENT HAS BEEN INITIATED BY MAKO SURGICAL. A SUPPLEMENTAL REPORT WILL BE SUBMITTED WHEN ADDITIONAL INFORMATION BECOMES AVAILABLE.
AFTER THE TKA MAKO CASE WAS DONE IT WAS NOTICED THE EXTRA-INCISION BONE PIN TIPS ON THE 3.2X110 BONE PINS USED HAD BOTH BROKEN OFF INSIDE THE PATIENT BONE. WHICH WERE LEFT INSTEAD OF BEING REMOVED. THIS IS THE 2ND INCIDENT AT OUR LOCATION ANY INFORMATION WOULD BE BENEFICIAL. SURGICAL DELAY: 16-30 MINUTES.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 590444 | BONE PIN, 3.2MM X 110MM, STERILE 2 PACK | STEREOTAXIC DEVICE, ROBOTICS | OLO | MAKO SURGICAL CORP. | W53978-1 | 00848486018139 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Hospitalization |