PASS LP PATIENT SPECIFIC
Received Jun 30, 2026 · Event occurred Jun 5, 2026
Report 3003120897-2026-01128 · MDR key 25664039
Device
Generic name
Thoracolumbosacral Pedicle Screw System
Manufacturer
Medtronic Sofamor Danek Usa, Inc.Model number
B33126099-01Catalog number
B33126099-01
Lot number
UNKNOWN
Product problems
- Break
Patient
67 YR · Male
- No Clinical Signs, Symptoms or Conditions
Narrative
Additional Manufacturer Narrative
MEDTRONIC SUBMITS THIS REPORT TO COMPLY WITH FDA REGULATIONS 21 CFR PARTS 4 AND 803. MEDTRONIC HAS MADE REASONABLE EFFORTS TO PROVIDE AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. MEDTRONIC WILL SUBMIT A SUPPLEMENTAL REPORT IF ADDITIONAL RELEVANT INFORMATION BECOMES KNOWN.
Description of Event or Problem
INFORMATION WAS RECEIVED FROM HEALTHCARE PROVIDER (HCP) VIA A MANUFACTURER REPRESENTATIVE REGARDING A PATIENT WITH IMPLANTED UNID ROD. IT WAS REPORTED THAT THE IMPLANTED ROD BROKE. THERE WERE NO PATIENT SYMPTOMS REPORTED. THERE WERE NO FURTHER COMPLICATIONS REPORTED REGARDING THE EVENT. ADDITIONAL INFORMATION STATED THAT THE FRACTURE WAS NOTICED IN A POST-OP X-RAY THAT WAS TAKEN ON (B)(6) 2025. IT WAS ALSO STATED THAT THE PATIENT UNDERWENT SPINAL FUSION PROCEDURE.