FDA Adverse Event Injury Summary report: N

XIA 3 TITANIUM BLOCKER

MDR report key: 21764074 · Received April 3, 2025

Report

Report Number
0009617544-2025-00029
Event Type
Injury
Date Received
April 3, 2025
Date of Event
December 9, 2024
Report Date
April 16, 2025
Manufacturer
STRYKER SPINE-US
Product Code
NKB
PMA / PMN Number
K142381
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
UT, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

WE RECEIVED FOUR POSSIBLE LOT NUMBERS FOR THE DEVICE AND WILL UPDATE THE RECORD IF WE RECEIVE MORE INFORMATION. THE LOT NUMBER COULD BE H78, HJJ, H9N, OR HBM.

Additional Manufacturer Narrative · 0

CORRECTED DATA: D4, H4.

Additional Manufacturer Narrative · 0

CORRECTED DATA: D4, H4 ADDITIONAL DATA: H3 H6 CODING HAS BEEN UPDATED TO REFLECT COMPLETION OF THE INVESTIGATION.

Description of Event or Problem · 0

A COMPANY REPRESENTATIVE REPORTED THAT IMAGING TAKEN APPROXIMATELY SIX MONTHS POST-OPERATIVELY REVEALED THAT THREE XIA 3 TITANIUM BLOCKERS MIGRATED. THE PATIENT THEN UNDERWENT REVISION SURGERY APPROXIMATELY EIGHT MONTHS POST-OPERATIVELY. THIS RECORD CAPTURES THE THIRD OF THREE XIA BLOCKERS.

Description of Event or Problem · 0

A COMPANY REPRESENTATIVE REPORTED THAT IMAGING TAKEN APPROXIMATELY SIX MONTHS POST-OPERATIVELY REVEALED THAT THREE XIA 3 TITANIUM BLOCKERS MIGRATED. THE PATIENT THEN UNDERWENT REVISION SURGERY APPROXIMATELY EIGHT MONTHS POST-OPERATIVELY. THIS RECORD CAPTURES THE THIRD OF THREE XIA BLOCKERS.

Description of Event or Problem · 0

A COMPANY REPRESENTATIVE REPORTED THAT IMAGING TAKEN APPROXIMATELY SIX MONTHS POST-OPERATIVELY REVEALED THAT THREE XIA 3 TITANIUM BLOCKERS MIGRATED. THE PATIENT THEN UNDERWENT REVISION SURGERY APPROXIMATELY EIGHT MONTHS POST-OPERATIVELY. THIS RECORD CAPTURES THE THIRD OF THREE XIA BLOCKERS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
654765 XIA 3 TITANIUM BLOCKER THORACOLUMBOSACRAL PEDICLE SCREW SYSTEM NKB STRYKER SPINE-US H78

Patients

Seq Age Sex Outcome Treatment
1 55 YR Male Required Intervention