FDA Adverse Event Injury Summary report: N

BIA-GEN

MDR report key: 22188874 · Received June 11, 2025

Report

Report Number
2249852-2025-00009
Event Type
Injury
Date Received
June 11, 2025
Date of Event
January 12, 2024
Report Date
June 11, 2025
Manufacturer
COLLAGEN MATRIX, INC.
Product Code
MQV
UDI-DI
00813954024110
PMA / PMN Number
K182074
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
OTHER

Narratives

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 PREVIOUSLY DIAGNOSED WITH SPINAL STENOSIS. PATIENT PARTICIPATED IN A STUDY IN WHICH THE BIA-GEN BIOACTIVE PRODUCT WAS UTILIZED ON (B)(6) 2023 FOR POSTEROLATOERAL SPINE SURGERY. PRODUCT IMPLANTED IN LOCATION L4-L5. OTHER CONCOMITANT MEDICAL TREATMENT WAS PERFORMED (L4-L5 LAMINECTOMY). BONE MARROW ASPIRATE, AUTOGRAFT AND GLOBUS CREO SCREWS/SABLE TLIF CAGE (NOT MANUFACTURED BY COLLAGEN MATRIX, INC) WERE ALSO UTILIZED WITH THE BIA-GEN PRODUCT FOR THE INITIAL SURGERY. CUSTOMER STATED THE BIA-GEN PRODUCT HANDLED AND PERFORMED EXCELLENT, AND THERE WERE NO NOTABLE COMPLICATIONS NOTED DURING IMPLANTATION. ON A FOLLOW-UP VISIT ON (B)(6) 2024, PATIENT REPORTED PAIN/SWELLING IN THE RIGHT CALF. THE SURGEON SENT THE PATIENT FOR AN ULTRASOUND THAT REVEALED A PARTIALLY OCCLUSIVE DEEP VEIN THROMBOSIS IN THE POPLITEAL VEIN. PATIENT RETURNED TO EMERGENCY DEPARTMENT ON (B)(6) 2024 WITH SHORTNESS OF BREATH AND CHEST PAIN. CT ANGIOGRAM OF THE CHEST WAS PERFORMED AND PATIENT WAS DIAGNOSED WITH PULMONARY THROMBOEMBOLISM. THE PATIENT WAS ADMITTED TO THE HOSPITAL ON (B)(6) 2024 AND DISCHARGED ON (B)(6) 2024. THE PATIENT ALSO COMPLETED A 6 MONTH COURSE OF ELIQUIS. CUSTOMER STATED THIS WAS NOT AN UNEXPECTED ADVERSE EVENT, AND THE EVENT IS UNRELATED TO THE INTERVENTION. THE STUDY INTERVENTION WAS NOT DISCONTINUED. IT WAS NOTED THE EVENT STOP DATE WAS 22JULY2024. THERE WERE NO DETAILS PROVIDED SURROUNDING TEH EVENT STOP DATE. NO FURTHER DETAILS SURROUNDING PATIENT STATUS, PATIENT OUTCOME, OR EVENT WILL BE PROVIDED. CUSTOMER ALSO STATED THE REPORTED INCIDENT WAS NOT RELATED TO THE BIA-GEN PRODUCT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
103507 BIA-GEN MINERAL COLLAGEN COMPOSITE BIOACTIVE MOLDABLE MQV COLLAGEN MATRIX, INC. CS-MCCBA-100 MCCBASAN230101 00813954024110

Patients

Seq Age Sex Outcome Treatment
1 67 YR Female Required Intervention| H