5.5 EXP VERSE FEN SCR 6.0X50 199723650

MAUDE Adverse Event Report

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 2019-02-12 for 5.5 EXP VERSE FEN SCR 6.0X50 199723650 manufactured by Medos International Sàrl Ch.

Event Text Entries

[136000269] Product complaint # (b)(4). Surgical intervention in the form of revision surgery (b)(4). Device is available for evaluation. Investigation will be conducted. Follow up will be filed with the investigation 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


[136000270] It was reported that during a revision surgery 2 of 4 verse innies were found loose beside the construct and 4 verse screws seemed loose as well. Already in the reop x-ray the innies seemed not tightened and the screws loose.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1526439-2019-51345
MDR Report Key8333590
Report SourceFOREIGN,HEALTH PROFESSIONAL
Date Received2019-02-12
Date of Report2019-01-21
Date of Event2019-01-21
Date Mfgr Received2019-04-09
Device Manufacturer Date2017-12-19
Date Added to Maude2019-02-12
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 ContactKARA DITTY-BOVARD
Manufacturer Street325 PARAMOUNT DRIVE
Manufacturer CityRAYNHAM MA 02767
Manufacturer CountryUS
Manufacturer Postal02767
Manufacturer Phone6103142063
Manufacturer G1MEDOS INT SPINE
Manufacturer StreetCHEMIN BLANC 38
Manufacturer CityLE LOCLE
Manufacturer CountrySZ
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand Name5.5 EXP VERSE FEN SCR 6.0X50
Generic NameBONE CEMENT, POSTERIOR SCREW AUGMENTATION
Product CodePML
Date Received2019-02-12
Returned To Mfg2019-02-06
Model Number199723650
Catalog Number199723650
Lot Number175149
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerMEDOS INTERNATIONAL SàRL CH
Manufacturer AddressCHEMIN-BLANC 38 LE LOCLE 02400 SZ 02400


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2019-02-12

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