MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2011-02-03 for COLD KNIFE, STRAIGHT BLADE, 3/PKG K-SB manufactured by Gyrus Acmi, Inc.
[16370304]
During a surgical procedure while using the elite cold knife straight blade, the blade broke off in the pt. The surgeon was able to retrieve the blade without harming the pt.
Patient Sequence No: 1, Text Type: D, B5
[16416967]
Performance report, no device is being returned; therefore we cannot determine the failure mode of the reported incident. We will monitor the complaint database for further occurrences. If further info becomes available, gyrus (b)(4) will continue the investigation and update the agency accordingly.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 3006159227-2011-00001 |
| MDR Report Key | 1981377 |
| Report Source | 06 |
| Date Received | 2011-02-03 |
| Date of Report | 2011-02-03 |
| Date of Event | 2011-01-03 |
| Date Facility Aware | 2011-01-04 |
| Date Mfgr Received | 2011-01-04 |
| Date Added to Maude | 2012-05-10 |
| 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 | 0 |
| Event Location | 3 |
| Manufacturer Contact | TERRENCE SULLIVAN |
| Manufacturer Street | 136 TURNPIKE RD |
| Manufacturer City | SOUTHBOROUGH MA 01772 |
| Manufacturer Country | US |
| Manufacturer Postal | 01772 |
| Manufacturer Phone | 5088042739 |
| Manufacturer G1 | GYRUS ACMI, INC |
| Manufacturer Street | CARRETERA SALTILLO- ZACATECAS KM 4.5 |
| Manufacturer City | LA ANGOSTURA,SALTILLO, COAHUIL CP 25000 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | CP 25000 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | COLD KNIFE, STRAIGHT BLADE, 3/PKG |
| Generic Name | COLD KNIFE, STRAIGHT BLADE, 3/PKG |
| Product Code | GDX |
| Date Received | 2011-02-03 |
| Model Number | K-SB |
| Catalog Number | K-SB |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | NA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | GYRUS ACMI, INC |
| Manufacturer Address | CARRETERA SALTILLO- ZACATECAS KM 4.5 LA ANGOSTURA, CP MX |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2011-02-03 |