MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2018-09-14 for UNIII AXS SCREWS, SELF-DRILLING, 1.5X5MM, 5/P 56-15935 manufactured by Stryker Leibinger Freiburg.
[120292677]
Device is not available for evaluation. If further information becomes available, it will be submitted in a supplemental report. Facility did not save device for return.
Patient Sequence No: 1, Text Type: N, H10
[120292678]
It was reported by the company representative that screws that were used to fixate a plate during a cranioplasty had come loose. A revision surgery was preformed to correct the issue.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0008010177-2018-00087 |
| MDR Report Key | 7877207 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2018-09-14 |
| Date of Report | 2018-09-14 |
| Date of Event | 2018-08-10 |
| Date Mfgr Received | 2018-08-17 |
| Date Added to Maude | 2018-09-14 |
| 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. KELLI DYKSTRA |
| Manufacturer Street | BOETZINGERSTR. 41 |
| Manufacturer City | FREIBURG D-79111 |
| Manufacturer Postal | D-79111 |
| Manufacturer Phone | 76145120 |
| Manufacturer G1 | STRYKER LEIBINGER FREIBURG |
| Manufacturer Street | BOETZINGERSTR. 41 |
| Manufacturer City | FREIBURG D-79111 |
| Manufacturer Postal Code | D-79111 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | UNIII AXS SCREWS, SELF-DRILLING, 1.5X5MM, 5/P |
| Generic Name | IMPLANT |
| Product Code | HBW |
| Date Received | 2018-09-14 |
| Catalog Number | 56-15935 |
| Lot Number | UNKNOWN |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | STRYKER LEIBINGER FREIBURG |
| Manufacturer Address | BOETZINGERSTR. 41 FREIBURG D-79111 D-79111 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2018-09-14 |