FDA Adverse Event Injury Summary report: N

DENALI SPINAL SYSTEM

MDR report key: 6506931 · Received April 20, 2017

Report

Report Number
3004774118-2017-00034
Event Type
Injury
Date Received
April 20, 2017
Date of Event
December 7, 2016
Report Date
March 21, 2017
Manufacturer
K2M, INC.
Product Code
NKB
PMA / PMN Number
K141873
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
VA, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

A COMPREHENSIVE INVESTIGATION WAS IMMEDIATELY INITIATED ON RECEIPT OF THE COMPLAINT. THE SUBJECT PRODUCT WAS RETURNED FOR EVALUATION BUT EVALUATION IS STILL IN PROGRESS. UPON COMPLETION OF EVALUATION OF THE SUBJECT PART, K2M INC. WILL FILE A SUPPLEMENTAL REPORT INDICATING THE FINDINGS.

Additional Manufacturer Narrative · 1

A COMPREHENSIVE INVESTIGATION WAS IMMEDIATELY INITIATED ON RECEIPT OF THE COMPLAINT. THE SUBJECT PRODUCT WAS RETURNED FOR EVALUATION BUT EVALUATION IS STILL IN PROGRESS. UPON COMPLETION OF EVALUATION OF THE SUBJECT PART, K2M INC. WILL FILE A SUPPLEMENTAL REPORT INDICATING THE FINDINGS. EVALUATION IN PROCESS.

Description of Event or Problem · 1

ON 03.21.2017 IT WAS REPORTED TO K2M, INC. THAT A REVISION SURGERY TOOK PLACE IN WHICH SCREWS WERE REMOVED. REVISION SURGERY TOOK PLACE (B)(6) 2016.

Description of Event or Problem · 1

ON 03.21.2017 IT WAS REPORTED TO K2M, INC. THAT A REVISION SURGERY TOOK PLACE IN WHICH ALL HARDWARE WAS REMOVED. REVISION SURGERY TOOK PLACE (B)(6) 2016.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
290378 DENALI SPINAL SYSTEM PEDICLE SCREW SPINAL SYSTEM NKB K2M, INC. UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 24 YR Required Intervention THE 101-10001 LOT JKB| THE 101-73040 LOT PUY| THE 101-80028 LOT BMH| THE 801-36535M LOT JEY| THE 801-36540 LOT LAB| THE 801-36540M LOT RLW| THE 801-36545M LOT RLX