• Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MSD DEGGENDORF MFG SOVEREIGN SPINAL SYSTEM

  • Print
  • Share
  • E-mail
-
Super Search Devices@FDA
510(k) | DeNovo | Registration & Listing | Adverse Events | Recalls | PMA | HDE | Classification | Standards
CFR Title 21 | Radiation-Emitting Products | X-Ray Assembler | Medsun Reports | CLIA | TPLC
 

MSD DEGGENDORF MFG SOVEREIGN SPINAL SYSTEM Back to Search Results
Catalog Number 7969214INT
Device Problem Break (1069)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Date 03/22/2018
Event Type  malfunction  
Manufacturer Narrative
This part is not approved for use in the united states; however a like device catalog # 7969214, 510k #k091813 and udi# (b)(4) was cleared in the united states.Product was not returned to the manufacturer for evaluation.Therefore, we are unable to determine the definitive cause of the reported event.If information is provided in the future, a supplemental report will be issued.
 
Event Description
Pre-operative diagnosis: spondylodese l5-s1.Type of procedure: decompression l5-s1 <(>&<)> ventrale spondylodese l5-s1 with anterior lumbar interbody fusion.It was reported that during surgery, the spacer cracked at the upper side of the screw hole at 180 degrees.The cage remains in the patient.No patient complications were reported during this event.
 
Search Alerts/Recalls

  New Search  |  Submit an Adverse Event Report

Brand Name
SOVEREIGN SPINAL SYSTEM
Manufacturer (Section D)
MSD DEGGENDORF MFG
wertstrasse 17
deggendorf 94469
Manufacturer (Section G)
MSD DEGGENDORF MFG
wertstrasse 17
deggendorf 94469
Manufacturer Contact
stacie ziemba
1800 pyramid place
memphis, TN 38132
9013963133
MDR Report Key7449445
MDR Text Key106384623
Report Number1030489-2018-00580
Device Sequence Number1
Product Code OVD
Combination Product (y/n)N
Reporter Country CodeSZ
PMA/PMN Number
SEE H10
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Reporter Occupation Physician
Type of Report Initial
Report Date 04/21/2018
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Catalogue Number7969214INT
Device Lot Number46EY
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Initial Date Manufacturer Received 03/22/2018
Initial Date FDA Received04/21/2018
Date Device Manufactured12/21/2017
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Patient Age31 YR
-
-