BEUDAMED
    FDA Adverse Event Injury Summary report: N

    COLLECT.NO.QAS SPINE ANTERIOR STABILIS.

    MDR report key: 18797409 · Received February 28, 2024

    Report

    Report Number
    2916714-2024-00040
    Event Type
    Injury
    Date Received
    February 28, 2024
    Report Date
    March 15, 2024
    Manufacturer
    AESCULAP AG
    Product Code
    QWK
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    INVESTIGATION RESULTS: THE DEVICE WAS NOT RETURNED TO THE MANUFACTURER FOR PHYSICAL EVALUATION. ADDITIONALLY, NO ON-SITE EVALUATION OF THE UNIT WAS PERFORMED AND NO PARTS WERE RETURNED FOR FAILURE ANALYSIS. THEREFORE, THE INVESTIGATION WAS NOT ABLE TO CONFIRM A DEVICE ISSUE THAT COULD BE ASSOCIATED WITH THE REPORTED EVENT. BATCH HISTORY REVIEW: THE DEVICE HISTORY RECORDS (DHR) WERE NOT ABLE TO BE REVIEWED AS NO LOT NUMBER WAS MADE AVAILABLE. HOWEVER, ALL DEVICE HISTORY RECORDS (DHR) ARE REVIEWED AND RELEASED ACCORDING TO DOCUMENTED PROCEDURES AND A DEVICE IS NOT RELEASED IF IT DOES NOT MEET REQUIREMENTS OR IS NONCONFORMING. CONCLUSION AND MEASURES / PREVENTATIVE MEASURES: A DEFINITIVE CONCLUSION REGARDING THE COMPLAINT INCIDENT CANNOT BE REACHED WITHOUT A PHYSICAL EXAMINATION OF THE COMPLAINT DEVICE.

    Additional Manufacturer Narrative · 0

    INVESTIGATION ON-GOING. SHOULD RELEVANT ADDITIONAL INFORMATION / INVESTIGATION RESULTS BECOME AVAILABLE, A SUPPLEMENTAL MEDWATCH REPORT WILL BE SUBMITTED.

    Description of Event or Problem · 0

    IT WAS REPORTED TO AESCULAP INC., VIA THE ANNUAL ACTIVL ENHANCED SAFETY SURVEILLANCE STUDY (ESS) COVERING A REPORTING PERIOD FROM (B)(6) 2023 TO (B)(6) 2023, THAT AN UNKNOWN ACTIV L DEVICE WAS IMPLANTED ON AN UNSPECIFIED DATE AT THE L5-S1 LEVEL. ACCORDING TO THE COMPLAINANT A SAFETY EVENT OCCURRED ON AN UNSPECIFIED DATE. THE EVENT WAS DESCRIBED AS DEVICE SUBSIDENCE. THE ADVERSE EVENT IS FILED UNDER AIC REFERENCE XC (B)(4). ASSOCIATED MEDWATCH REPORTS: 2916714-2024-00024. 2916714-2024-00025. 2916714-2024-00026. 2916714-2024-00027. 2916714-2024-00028. 2916714-2024-00029. 2916714-2024-00030. 2916714-2024-00031. 2916714-2024-00032. 2916714-2024-00033. 2916714-2024-00034. 2916714-2024-00035. 2916714-2024-00036. 2916714-2024-00037. 2916714-2024-00038. 2916714-2024-00039. 2916714-2024-00041.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1223008 COLLECT.NO.QAS SPINE ANTERIOR STABILIS. IMPLANTS/DISPOSABLES ANTERIOR QWK AESCULAP AG

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown Disability| O