MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2011-06-17 for BIPASS DISPOSABLE PUSHER SINGLE PACK N/A 902093 manufactured by Biomet Sports Medicine.
[2083123]
It was reported that a patient underwent a procedure utilizing a nitinol wire pusher on (b)(6) 2011. During the procedure, the nitinol wire pusher would not pass the suture through the patient's rotator cuff and reportedly bent. Another nitinol wire pusher was attempted with the same result. This caused a delay of greater than thirty minutes to the procedure.
Patient Sequence No: 1, Text Type: D, B5
[9017071]
Review of device history records show that lot released with no recorded anomaly or deviation. Evaluation in process but not yet complete. Upon completion of evaluation, a follow up report will be sent to the fda. (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[9401955]
Evaluation of the returned device found that it functioned as intended. This report filed (b)(4), 2011.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1825034-2011-00517 |
| MDR Report Key | 2132765 |
| Report Source | 07 |
| Date Received | 2011-06-17 |
| Date of Report | 2011-05-25 |
| Date of Event | 2011-05-03 |
| Date Mfgr Received | 2011-05-25 |
| Device Manufacturer Date | 2010-09-14 |
| Date Added to Maude | 2011-06-20 |
| 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 | 0 |
| Manufacturer Contact | MR. VICTOR RODGERS |
| Manufacturer Street | 56 EAST BELL DRIVE P.O. BOX 587 |
| Manufacturer City | WARSAW IN 465810587 |
| Manufacturer Country | US |
| Manufacturer Postal | 465810587 |
| Manufacturer Phone | 5743713800 |
| Manufacturer G1 | BIOMET SPORTS MEDICINE |
| Manufacturer Street | 56 EAST BELL DRIVE P.O. BOX 587 |
| Manufacturer City | WARSAW IN 46581058 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 46581 0587 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BIPASS DISPOSABLE PUSHER SINGLE PACK |
| Generic Name | PUSHER |
| Product Code | HXO |
| Date Received | 2011-06-17 |
| Returned To Mfg | 2011-06-10 |
| Model Number | N/A |
| Catalog Number | 902093 |
| Lot Number | 343600 |
| ID Number | N/A |
| Operator | PHYSICIAN |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BIOMET SPORTS MEDICINE |
| Manufacturer Address | 56 EAST BELL DRIVE P.O. BOX 587 WARSAW IN 46581058 US 46581 0587 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2011-06-17 |