BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TSRH 3D 6.5 X 50 MM SCREW, TI

    MDR report key: 915879 · Received August 19, 2004

    Report

    Report Number
    1030489-2004-00091
    Event Type
    Malfunction
    Date Received
    August 19, 2004
    Date of Event
    July 20, 2004
    Report Date
    July 20, 2004
    Manufacturer
    MEDTRONIC SOFAMOR DANEKMANUFACTURING
    Product Code
    KWG
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TSRH 3D 6.5 X 50 MM SCREW, TI BONE SCREW KWG MEDTRONIC SOFAMOR DANEKMANUFACTURING NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 39 YR