| Brand Name | PRECICE STRYDE SYSTEM |
| Common Device Name | ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES |
| Manufacturer (Section D) |
| NUVASIVE SPECIALIZED ORTHOPEDICS, INC. |
| 101 enterprise dr, suite 100 |
| aliso viejo CA 92656 |
|
| MDR Report Key | 12232686 |
| Report Number | 3006179046-2021-00416 |
| Device Sequence Number | 17144470 |
| Product Code |
HSB
|
| UDI-Device Identifier | 00887517950765 |
| UDI-Public | 887517950765 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | SN |
| PMA/510(K) Number | K180503 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2020 |
| Device Explanted Year | 2021 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
distributor,foreign,health pr |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
07/27/2021 |
| 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? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Model Number | PS10.0-80B265 |
| Device Lot Number | 0011645AAA |
| Was Device Available for Evaluation? |
No
|
| Was the Report Sent to FDA? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/05/2021 |
| Initial Report FDA Received Date | 07/27/2021 |
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
|
|