Brand Name | TILOCK MODULAR SPINAL SYSTEM |
Type of Device | ORTHOSIS, SPINAL PEDICLE FIXATION |
Manufacturer (Section D) |
GENESYS SPINE |
1250 s. capital of tx hwy |
building 3, suite 600 |
austin, tx |
|
Manufacturer Contact |
andrew
davison
|
1250 s. capital of tx hwy |
building 3, suite 600 |
austin, tx
|
3817070
|
|
MDR Report Key | 10143183 |
MDR Text Key | 194809079 |
Report Number | 3008455034-2020-00002 |
Device Sequence Number | 1 |
Product Code |
MNI
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K172469 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
06/03/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | SEE EVALUATION SUMMARY |
Device Catalogue Number | SEE EVALUATION SUMMARY |
Device Lot Number | SEE EVALUATION SUMMARY |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
05/21/2020
|
Initial Date FDA Received | 06/11/2020 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 06/22/2018 |
Is the Device Single Use? |
Yes
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 59 YR |
|
|