MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,05,07 report with the FDA on 2015-04-16 for CENTERPIECE? PLATE FIXATION SYSTEM G9010000274 manufactured by Warsaw Orthopedic, Inc..
[5652332]
It was reported on an unknown date, that the patient underwent a laminoplasty surgery at levels c3 to c6. Post-op, it was reported that a screw had backed out at the c6 lamina. No patient complications were reported as a result of this event.
Patient Sequence No: 1, Text Type: D, B5
[13143583]
(b)(6). (b)(4). Pma 510(k): these parts are not approved for use in the united states; however, the catalog # 853-465 and 510k # k050082 of 'like devices' were cleared in the united states.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1030489-2015-00805 |
| MDR Report Key | 4699868 |
| Report Source | 01,05,07 |
| Date Received | 2015-04-16 |
| Date of Report | 2015-03-19 |
| Date Mfgr Received | 2015-03-19 |
| Date Added to Maude | 2015-05-18 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | HUZEFA MAMOOLA |
| Manufacturer Street | 1800 PYRAMID PLACE |
| Manufacturer City | MEMPHIS TN 38132 |
| Manufacturer Country | US |
| Manufacturer Postal | 38132 |
| Manufacturer Phone | 9013963133 |
| Manufacturer G1 | MEDTRONIC SOFAMOR DANEK |
| Manufacturer Street | 1800 PYRAMID PLACE |
| Manufacturer City | MEMPHIS TN 38132 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 38132 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CENTERPIECE? PLATE FIXATION SYSTEM |
| Generic Name | ORTHOSIS, SPINE, PLATE, LAMINOPLASTY, METAL |
| Product Code | NQW |
| Date Received | 2015-04-16 |
| Model Number | NA |
| Catalog Number | G9010000274 |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | WARSAW ORTHOPEDIC, INC. |
| Manufacturer Address | 2500 SILVEUS CROSSING WARSAW IN 46582 US 46582 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2015-04-16 |