| Brand Name | CONTOURED ROD; SIZE Ø5.5X45 MM, TI |
| Common Device Name | THORACOLUMBOSACRAL PEDICLE SCREW SYSTEM |
| Manufacturer (Section D) |
| K2M, INC. |
| 600 hope parkway se |
| leesburg VA 20175 |
|
| Manufacturer (Section G) |
| K2M, INC. |
| 600 hope parkway se |
|
| leesburg VA 20175 |
|
| Manufacturer Contact |
|
catherine
devarenne
|
| 2 pearl court |
| allendale, NJ 07401
|
|
2017608000
|
|
| MDR Report Key | 23706637 |
| Report Number | 3004774118-2025-00200 |
| Device Sequence Number | 21501101 |
| Product Code |
NKB
|
| UDI-Device Identifier | 10888857006720 |
| UDI-Public | (01)10888857006720(11)250702(10)2DN4 |
| Combination Product (Y/N) | N |
| Initial Reporter State | NY |
| Initial Reporter Country | US |
| PMA/510(K) Number | K141873 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Explanted Year | 2025 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Company Representative |
| Initial Reporter Occupation |
Other
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
02/20/2026 |
| 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 Catalogue Number | 101-65545 |
| Device Lot Number | 2DN4 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 11/11/2025 |
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Follow-Up |
| Initial Date Received by Manufacturer | 11/03/2025 |
| Supplement Date Received by Manufacturer | 01/26/2026
|
| Initial Report FDA Received Date | 12/03/2025 |
| Supplement Report FDA Received Date | 02/20/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 07/02/2025 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Sex | Unknown |