MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,health professional report with the FDA on 2018-12-20 for 5.5 EXP VERSE FEN SCR 6.0X45 199723645 manufactured by Medos International Sàrl Ch.
[131127818]
Product complaint # (b)(4). A complaint investigation will be performed. The complaint product is not available for the investigation. A supplemental report is not anticipated unless the results of the complaint investigation identify a corrective action or additional relevant information. Should the product become available, a physical evaluation will be conducted and a supplemental report filed with the results. If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10
[131127819]
It was reported that the verse advanced screws broke post. Op in the vertebral body. Patient consequence? :unknown.
Patient Sequence No: 1, Text Type: D, B5
Report Number | 1526439-2018-51165 |
MDR Report Key | 8185812 |
Report Source | FOREIGN,HEALTH PROFESSIONAL |
Date Received | 2018-12-20 |
Date of Report | 2018-12-03 |
Date of Event | 2018-01-01 |
Date Mfgr Received | 2018-12-03 |
Date Added to Maude | 2018-12-20 |
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 | KARA DITTY-BOVARD |
Manufacturer Street | 325 PARAMOUNT DRIVE |
Manufacturer City | RAYNHAM MA 02767 |
Manufacturer Country | US |
Manufacturer Postal | 02767 |
Manufacturer Phone | 6103142063 |
Manufacturer G1 | MEDOS INT SPINE |
Manufacturer Street | CHEMIN BLANC 38 |
Manufacturer City | LE LOCLE |
Manufacturer Country | SZ |
Single Use | 3 |
Previous Use Code | 3 |
Event Type | 3 |
Type of Report | 3 |
Brand Name | 5.5 EXP VERSE FEN SCR 6.0X45 |
Generic Name | BONE CEMENT, POSTERIOR SCREW AUGMENTATION |
Product Code | PML |
Date Received | 2018-12-20 |
Model Number | 199723645 |
Catalog Number | 199723645 |
Operator | HEALTH PROFESSIONAL |
Device Availability | N |
Device Eval'ed by Mfgr | R |
Device Sequence No | 1 |
Device Event Key | 0 |
Manufacturer | MEDOS INTERNATIONAL SàRL CH |
Manufacturer Address | CHEMIN-BLANC 38 LE LOCLE 02400 SZ 02400 |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 1. Other | 2018-12-20 |