MIS TI CFX FEN POLY 7X65 186727765

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2019-03-13 for MIS TI CFX FEN POLY 7X65 186727765 manufactured by Medos International Sàrl Ch.

Event Text Entries

[142503754] (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


[142503755] It was reported that - the head of the screw was disassembled when the alignment guide was introduced with a hammer for inserting the lock cap in a viper cortical fix fenestrated screw. The square thread of 2 verse correction keys were broken when they were inserted in the head of the screw. Was surgery delayed due to the reported event? --> no, action taken when event occurred? --> to change the screw and the correction keys, was procedure successfully completed? --> yes, were fragments generated? --> yes, if yes, were they removed easily without additional intervention? --> yes, patient status/ outcome / consequences --> no, patient consequence description/was there a clinical outcome experienced by the patient (infection, inflammation, etc. )? --> no, was other medical intervention (e. G. X-rays, additional procedures, prescriptions, otc, revision) required: --> no, is the patient part of a clinical study --> no.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1526439-2019-51446
MDR Report Key8416828
Report SourceCOMPANY REPRESENTATIVE,FOREIG
Date Received2019-03-13
Date of Report2019-02-22
Date of Event2019-02-21
Date Mfgr Received2019-05-22
Device Manufacturer Date2013-11-11
Date Added to Maude2019-03-13
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
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 NameMIS TI CFX FEN POLY 7X65
Generic NameBONE CEMENT, POSTERIOR SCREW AUGMENTATION
Product CodePML
Date Received2019-03-13
Model Number186727765
Catalog Number186727765
Lot NumberAPNDJ4
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerMEDOS INTERNATIONAL SàRL CH
Manufacturer AddressCHEMIN-BLANC 38 LE LOCLE 02400 SZ 02400


Patients

Patient NumberTreatmentOutcomeDate
10 2019-03-13

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