DYNESYS L I S FUSION CORD 200 N/A 01.03711.200

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2018-09-14 for DYNESYS L I S FUSION CORD 200 N/A 01.03711.200 manufactured by Zimmer Gmbh.

Event Text Entries

[120241412] Additional device information unique identifier (udi) # (b)(4). As no lot number was provided, the device history records could not be reviewed. The manufacturer did not receive the device yet, however it is indicated by complainant that it will be returned for investigation. Additional information has been requested and is currently not available. A cause for this specific event cannot be ascertained from the information provided. As soon as supplemental information becomes available, an updated report will be submitted. Zimmer biomet? S reference number of this file is (b)(4).
Patient Sequence No: 1, Text Type: N, H10


[120241413] It was reported that the patient underwent revision surgery due to cord breakage in 3 places.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number0009613350-2018-00999
MDR Report Key7875996
Report SourceHEALTH PROFESSIONAL
Date Received2018-09-14
Date of Report2019-02-21
Date of Event2018-08-15
Date Mfgr Received2019-02-13
Date Added to Maude2018-09-14
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. CHRISTINA ARNT
Manufacturer Street56 E. BELL DR.
Manufacturer CityWARSAW IN 46582
Manufacturer CountryUS
Manufacturer Postal46582
Manufacturer Phone5745273773
Manufacturer G1ZIMMER GMBH
Manufacturer StreetSULZER ALLEE 8 SULZER INDUSTRIE PARK
Manufacturer CityWINTERTHUR 8404
Manufacturer CountrySZ
Manufacturer Postal Code8404
Single Use3
Previous Use Code3
Removal Correction NumberN/A
Event Type3
Type of Report3

Device Details

Brand NameDYNESYS L I S FUSION CORD 200
Generic NameDYNESYS SPINAL SYSTEM
Product CodeNQP
Date Received2018-09-14
Model NumberN/A
Catalog Number01.03711.200
Lot NumberN/A
OperatorLAY USER/PATIENT
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerZIMMER GMBH
Manufacturer AddressSULZER ALLEE 8 SULZER INDUSTRIE PARK WINTERTHUR 8404 SZ 8404


Patients

Patient NumberTreatmentOutcomeDate
101. Hospitalization; 2. Required No Informationntervention 2018-09-14

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