FDA Adverse Event Other Summary report: N

VOLAR SMARTLOCK DISTAL RADIUS PLATE, NARROW, LEFT

MDR report key: 2111058 · Received May 20, 2011

Report

Report Number
8010177-2011-00143
Event Type
Other
Date Received
May 20, 2011
Date of Event
April 29, 2011
Report Date
April 29, 2011
Manufacturer
STRYKER OSTEOSYNTHESIS FREIBURG
Product Code
HRS
PMA / PMN Number
K040022
Removal / Correction Number
NA
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
OH, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

THE DEVICE WAS NOT RETURNED; THEREFORE, THE INCIDENT COULD NOT BE CONFIRMED. IT COULD ONLY BE ASSUMED THAT THE ROOT CAUSE IS MOST LIKELY ATTRIBUTED TO AN OVERLOAD THAT CAUSED THE POSTOPERATIVE BENDING OF THE PLATE. NO FURTHER INVESTIGATIONS COULD HAVE BEEN CONDUCTED BECAUSE NEITHER THE PLATE, X-RAYS, NOR ANY LOT # WAS SUBMITTED.

Description of Event or Problem · 1

"PT FELL AND THE PLATE BENT UPON FALL SO REVISION WAS REQUIRED."

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 VOLAR SMARTLOCK DISTAL RADIUS PLATE, NARROW, LEFT IMPLANT HRS STRYKER OSTEOSYNTHESIS FREIBURG NA UNK

Patients

Seq Age Sex Outcome Treatment
1 UNK Other