MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1992-07-31 for WURZBURG TITANIUM BONE SCREW N/A 01-0409-9MM manufactured by Walter Lorenz Surgical Instruments.
[2060]
Titanium bone screw broke off at head while being implanted into left mandigle. Device labeled for single use. Patient medical status prior to event: satisfactory condition. There was not multiple patient involvement. Invalid data - on device service/maintenance. No data - regarding date last serviced. Service provided by: invalid data. Invalid data - service records availability. No imminent hazard to public health claimed. Device used as labeled/intended. Device was evaluated after the event. Method of evaluation: actual device involved in incident was evaluated, visual examination. Results of evaluation: mechanical problem, incorrect technique/procedure, unanticipated short term complication of procedure. Conclusion: user error contributed to event. Certainty of device as cause of or contributor to event: yes. Corrective actions: inserviced by other facility staff. The device was not destroyed/disposed of.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3417 |
| MDR Report Key | 3417 |
| Date Received | 1992-07-31 |
| Date of Report | 1992-03-23 |
| Date of Event | 1992-03-23 |
| Date Facility Aware | 1992-03-23 |
| Report Date | 1992-03-23 |
| Date Reported to FDA | 1992-03-23 |
| Date Reported to Mfgr | 1992-03-23 |
| Date Added to Maude | 1993-04-19 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | WURZBURG TITANIUM BONE SCREW |
| Generic Name | SCREW, BONE |
| Product Code | HWD |
| Date Received | 1992-07-31 |
| Model Number | N/A |
| Catalog Number | 01-0409-9MM |
| Lot Number | N/A |
| ID Number | N/A |
| Operator | OTHER HEALTH CARE PROFESSIONAL |
| Device Availability | Y |
| Implant Flag | Y |
| Device Sequence No | 1 |
| Device Event Key | 3183 |
| Manufacturer | WALTER LORENZ SURGICAL INSTRUMENTS |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 1992-07-31 |