Brand Name | X-STOP PEEK INTERSPINOUS SPACER |
Type of Device | PROSTHESIS, SPINOUS PROCESS SPACER/PLATE |
Manufacturer (Section D) |
MEDTRONIC SOFAMOR DANEK USA, INC |
4340 swinea rd |
memphis TN 38118 |
|
Manufacturer (Section G) |
MEDTRONIC SOFAMOR DANEK USA, INC |
4340 swinea rd |
|
memphis TN 38118 |
|
Manufacturer Contact |
stacie
ziemba
|
1800 pyramid place |
memphis, TN 38132
|
9013963133
|
|
MDR Report Key | 6617189 |
MDR Text Key | 76818129 |
Report Number | 1030489-2017-01461 |
Device Sequence Number | 1 |
Product Code |
NQO
|
UDI-Device Identifier | 00643169132832 |
UDI-Public | 00643169132832 |
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | P040001 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
foreign,health professional,s |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
05/12/2017 |
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 Expiration Date | 10/04/2012 |
Device Catalogue Number | 1-3210 |
Device Lot Number | 2232391 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
05/12/2017
|
Initial Date FDA Received | 06/07/2017 |
Supplement Dates Manufacturer Received | 05/12/2017
|
Supplement Dates FDA Received | 09/07/2017
|
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 10/26/2010 |
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 Outcome(s) |
Other;
|
Patient Age | 81 YR |
Patient Weight | 53 |
|
|