BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AVIATOR ASSY ONE LEVEL PLATE SIZE 16

    MDR report key: 2081971 · Received April 5, 2011

    Report

    Report Number
    9617544-2011-00127
    Event Type
    Malfunction
    Date Received
    April 5, 2011
    Date of Event
    March 22, 2011
    Report Date
    March 22, 2011
    Manufacturer
    STRYKER SPINE BORDEAUX
    Product Code
    KWQ
    PMA / PMN Number
    K083562
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    ADDITIONAL INFORMATION HAS BEEN REQUESTED AND IF MADE AVAILABLE WILL BE REPORTED IN A SUPPLEMENTAL. METHOD, RESULT, AND CONCLUSION WILL BE MADE AVAILABLE FOLLOWING ENGINEERING EVALUATION.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT "PLATE WOULD NOT LOCK"

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AVIATOR ASSY ONE LEVEL PLATE SIZE 16 IMPLANT KWQ STRYKER SPINE BORDEAUX NA 106254

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK