MAUDE Adverse Event Report: STRYKER SPINE-SWITZERLAND XIA LP POLYAXIAL SCREW 5.5 X 40MM; SPINAL INTERVERTEBRAL BODY FIXATION ORTHOSIS

Model Number 03821540

Device Problems Break (1069); Fracture (1260); Material Integrity Problem (2978)

Patient Problems Pain (1994); No Information (3190)

Event Date 06/30/2016

Event Type  malfunction  

Event Description

It was reported that; screws broke.

Event Description

It was reported that; screws broke.

• Brand Name: XIA LP POLYAXIAL SCREW 5.5 X 40MM
• Type of Device: SPINAL INTERVERTEBRAL BODY FIXATION ORTHOSIS
• Manufacturer (Section D): STRYKER SPINE-SWITZERLAND; le crêt-du-locle 10 a; -; la chaux-de-fonds 2300 ; CH 2300
• Manufacturer (Section G): STRYKER SPINE-SWITZERLAND; le crêt-du-locle 10 a; -; la chaux-de-fonds 2300 ; CH 2300
• Manufacturer Contact: christa marrow ; 2 pearl court; allendale, NJ 07401 ; 2017608000
• MDR Report Key: 6976222
• MDR Text Key: 90945158
• Report Number: 3005525032-2017-00099
• Device Sequence Number: 1
• Product Code: KWQ
• UDI-Device Identifier: 04546540149176
• UDI-Public: (01)04546540149176
• Combination Product (y/n): N
• PMA/PMN Number: K060361
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 12/21/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/25/2017
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Model Number: 03821540
• Device Catalogue Number: 03821540
• Device Lot Number: 0036787
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 09/29/2017
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 05/21/2012
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Age: 62 YR