| Brand Name | PRECICE® INTRAMEDULLARY LIMB LENGTHENING ROD |
| Common Device Name | ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES |
| Manufacturer (Section D) |
| NUVASIVE SPECIALIZED ORTHOPEDICS, INC. |
| 101 enterprise |
| suite 100 |
| aliso viejo CA 92656 |
|
| MDR Report Key | 5609736 |
| Report Number | 3006179046-2016-00010 |
| Device Sequence Number | 10785071 |
| Product Code |
HSB
|
| UDI-Device Identifier | 00812258020484 |
| UDI-Public | (01)00812258020484(17)20161130(10)A141212-19(11)20141201 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | UK |
| PMA/510(K) Number | K141023 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2015 |
| Device Explanted Year | 2016 |
| Reporter Type |
Manufacturer
|
| Report Source |
distributor,health profession |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
01/14/2016 |
| 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
|
| Operator of Device |
Physician
|
| Device Expiration Date | 12/01/2016 |
| Device Model Number | P10.7-80C335 |
| Device Lot Number | A141212-19-0AA |
| Was Device Available for Evaluation? |
No
|
| Type of Report(Section G) | FDA Requested |
| Initial Date Received by Manufacturer | 01/14/2016 |
| Supplement Date Received by Manufacturer | Not provided
|
| Initial Report FDA Received Date | 04/26/2016 |
| Supplement Report FDA Received Date | 07/01/2016
|
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 |
Hospitalization;
|
| Patient Age | 20 YR |
| Patient Weight | 82 |
|
|