MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2017-12-04 for FUTURA CSI SUBTALAR IMPLANT DIAMETER 11 CSI-11 manufactured by Tornier Inc..
[93586795]
Patient Sequence No: 1, Text Type: N, H10
[93586796]
It was reported that the screw became loose at 3 days post-op.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3004983210-2017-00029 |
| MDR Report Key | 7078602 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2017-12-04 |
| Date of Report | 2017-07-27 |
| Date of Event | 2017-06-25 |
| Date Mfgr Received | 2017-07-27 |
| Date Added to Maude | 2017-12-04 |
| 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 | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. DUSTIN SMITH |
| Manufacturer Street | 10801 NESBIT AVE SOUTH |
| Manufacturer City | BLOOMINGTON MN 55437 |
| Manufacturer Country | US |
| Manufacturer Postal | 55437 |
| Manufacturer Phone | 9529217121 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | FUTURA CSI SUBTALAR IMPLANT DIAMETER 11 |
| Generic Name | SUBTALAR PEG IMPLANT |
| Product Code | MJW |
| Date Received | 2017-12-04 |
| Catalog Number | CSI-11 |
| Operator | PHYSICIAN |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TORNIER INC. |
| Manufacturer Address | 10801 NESBIT AVENUE SOUTH BLOOMINGTON MN 55437 US 55437 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2017-12-04 |