MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,05,08 report with the FDA on 2008-04-25 for NEXGEN COMPLETE KNEE SOLUTION ARTICULAR SURFACE INSERTION INSTRUMENT 00597702000 manufactured by Zimmer, Inc..
[859132]
It is reported that when the doctor should lock the insert of the instrument, the tip part that has a small hook on it broke.
Patient Sequence No: 1, Text Type: D, B5
[7998853]
This report will be amended when our investigation is complete.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1822565-2008-00199 |
| MDR Report Key | 1034639 |
| Report Source | 01,05,08 |
| Date Received | 2008-04-25 |
| Date of Report | 2008-03-27 |
| Date of Event | 2008-03-05 |
| Date Facility Aware | 2008-03-27 |
| Report Date | 2008-03-27 |
| Date Mfgr Received | 2008-03-27 |
| Device Manufacturer Date | 2006-10-01 |
| Date Added to Maude | 2008-10-01 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | ANN RECKTENWALL |
| Manufacturer Street | PO BOX 708 |
| Manufacturer City | WARSAW IN 465810708 |
| Manufacturer Country | US |
| Manufacturer Postal | 465810708 |
| Manufacturer Phone | 5743718028 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | NEXGEN COMPLETE KNEE SOLUTION ARTICULAR SURFACE INSERTION INSTRUMENT |
| Generic Name | KNEE INSTRUMENT |
| Product Code | LJW |
| Date Received | 2008-04-25 |
| Returned To Mfg | 2008-04-10 |
| Model Number | NA |
| Catalog Number | 00597702000 |
| Lot Number | 60577285 |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | NA |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | B |
| Device Sequence No | 1 |
| Device Event Key | 1031160 |
| Manufacturer | ZIMMER, INC. |
| Manufacturer Address | P.O. BOX 708 WARSAW IN 465810708 US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2008-04-25 |