| Brand Name | Spine instrument |
| Common Device Name | MySpine Cervical Probe Ø3.2 -35mm Mech stop short |
| Manufacturer (Section D) |
| Medacta International SA |
| strada regina |
| castel san pietro 6874 |
| SZ 6874 |
|
| Manufacturer Contact |
|
marco
giannessi
|
| strada regina |
| castel san pietro 6874
|
|
SZ
6874
|
|
| MDR Report Key | 50006552 |
| Report Number | 3005180920-2026-00785 |
| Device Sequence Number | 13376295 |
| Product Code |
LXH
|
| UDI-Device Identifier | 07630542716263 |
| UDI-Public | 07630542716263 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | US |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Company Representative |
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
09/23/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
No
|
| Is this a Product Problem Report? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Model Number | 03.75.10.0348 |
| Device Lot Number | 2475311 |
| Was Device Available for Evaluation? |
Yes
|
| Date Returned to Manufacturer | 08/25/2026 |
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/15/2026 |
| Supplement Date Received by Manufacturer | Not provided
|
| Initial Report FDA Received Date | 07/27/2026 |
| Supplement Report FDA Received Date | 09/23/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 10/10/2024 |
| Is the Device Labeled for Single Use? (Y/N) |
No
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Reuse
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Other;
|
| Patient Age | 56 YR |
| Patient Sex | Male |
| Patient Race | Asian |
|
|