FDA Adverse Event Injury Summary report: N

CSLP VARABLE ANGLE LOCKING PLATE 4 LEVEL

MDR report key: 1241771 · Received November 20, 2008

Report

Report Number
2520274-2008-00109
Event Type
Injury
Date Received
November 20, 2008
Report Date
October 26, 2008
Manufacturer
SYNTHES (USA)
Product Code
HRS
PMA / PMN Number
NI
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
PA, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

ADDITIONAL INFO HAS BEEN REQUESTED. THE DATE OF MANUFACTURE CANNOT BE DETERMINED WITHOUT A LOT NUMBER. THE INVESTIGATION CANNOT BE COMPLETED. NO CONCLUSION CAN BE DRAWN, AS NO PRODUCT WAS RETURNED AND NO LOT NUMBER IS AVAILABLE.

Description of Event or Problem · 1

AFTER IMPLANTATION FOUR SCREWS WERE FOUND TO BE BACKING OUT OF THE CSLP VARIABLE ANGLE LOCKING PLATE. SURGEON REMOVED THE SCREWS AND REVISED WITH RESCUE SCREWS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 CSLP VARABLE ANGLE LOCKING PLATE 4 LEVEL LOCKING PLATES HRS SYNTHES (USA) NA NI

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention SCREWS