FDA Adverse Event Injury Summary report: N

BIOCORE

MDR report key: 22162085 · Received June 6, 2025

Report

Report Number
2249852-2025-00014
Event Type
Injury
Date Received
June 6, 2025
Report Date
June 6, 2025
Manufacturer
COLLAGEN MATRIX, INC.
Product Code
MQV
UDI-DI
00813954024769
PMA / PMN Number
K182074
Report Source
Manufacturer report
Reporter Location
NJ, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

THIS PARENT MDR IS MDR. THIS MDR IS FOR SUSPECT DEVICE 2.

Description of Event or Problem · 0

COMPLAINT SUBMITTED THROUGH CLINICAL DATA COLLECTION. LIMITED INFORMATION PROVIDED AND IT IS UNLIKELY FURTHER INFORMATION SURROUNDING THE PATIENT OR THE EVENT WILL BE PROVIDED. PATIENT WAS DIAGNOSED WITH CHRONIC LOWER BACKPAIN. TWO ITEMS OF THE BIOCORE MINERAL COLLAGEN COMPOSITE BIOACTIVE MOLDABLE WERE USED ON A PATIENT DURING INITIAL SURGERY ON (B)(6) 2024. PRODUCT WAS IMPLANTED IN PATIENT IN LOCATION L3-4 AND L4-5. A BONE MARROW ASPIRATE AND ALLOGRAFT (NOT COLLAGEN MATRIX, INC. PRODUCTS) WERE USED IN CONJUNCTION WITH THE BIOCORE BIOACTIVE PRODUCT. ADDITIONALLY, IT WAS REPORTED THAT INVICTUS SCREWS AND A CAGE WAS ALSO USED (NOT COLLAGEN MATRIX, INC. PRODUCTS). CUSTOMER REPORTED NO COMPLICATIONS WERE NOTED DURING IMPLANT AND THE PRODUCT HANDLED AND PERFORMED EXCELLENT. ON (B)(6) 2024 THERE WAS MILD ANTERIOR SUBSIDENCE OF THE L4-L5 CAGE INTO THE ANTERIOR L5 VERTEBRAL BODY. CUSTOMER CONFIRMED THIS WAS NOT A SERIOUS ADVERSE EVENT AND REPORTED PHYSICAL THERAPY AS THE BEHAVIORAL/LIFESTYLE INTERVENTION FOR THE PATIENT. CUSTOMER STATED PATIENT WAS TO START PHYSICAL THERAPY ON (B)(6) 2024. NO FURTHER DETAILS SURROUNDING OUTCOME OF PHYSICAL THERAPY, PATIENT STATUS, AND PATIENT OUTCOME WILL BE PROVIDED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1463005 BIOCORE MINERAL COLLAGEN COMPOSITE BIOACTIVE MOLDABLE MQV COLLAGEN MATRIX, INC. 214-0060-ST FB220502 00813954024769

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown