MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2015-04-17 for ULTRA DRIVE 6MM PLUG PULLER N/A 423868 manufactured by Biomet Orthopedics.
[22152533]
It was reported that patient underwent a right initial total shoulder arthroplasty on (b)(6) 2014. Subsequently, patient was revised on an unknown date in (b)(6) 2014 due to infection. All parts were removed except the stem.
Patient Sequence No: 1, Text Type: D, B5
[22273422]
Current information is insufficient to permit a conclusion as to the cause of the event. Review of device history records show that lot released with no complaint related anomaly or deviation. Review of sterilization certification confirms device was sterilized in accordance with iso 11137-2. This report is number 1 of 5 mdrs filed for the same event (reference 1825034-2015- 01550 / 01554).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 0001825034-2015-01550 |
| MDR Report Key | 4704538 |
| Report Source | 07 |
| Date Received | 2015-04-17 |
| Date of Report | 2015-03-23 |
| Date of Event | 2015-03-24 |
| Date Mfgr Received | 2015-03-23 |
| Device Manufacturer Date | 2014-02-13 |
| Date Added to Maude | 2015-04-20 |
| 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 | MS. MEGAN HAAS |
| Manufacturer Street | 56 E. BELL DRIVE |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal | 46582 |
| Manufacturer Phone | 5743726700 |
| Manufacturer G1 | BIOMET ORTHOPEDICS |
| Manufacturer Street | 56 E. BELL DRIVE |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 46582 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | N/A |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ULTRA DRIVE 6MM PLUG PULLER |
| Generic Name | NERVE CONDUCTION VELOCITY MEASUREMENT DEVICE |
| Product Code | JXE |
| Date Received | 2015-04-17 |
| Model Number | N/A |
| Catalog Number | 423868 |
| Lot Number | 976140 |
| ID Number | N/A |
| Operator | PHYSICIAN |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BIOMET ORTHOPEDICS |
| Manufacturer Address | 56 E. BELL DRIVE WARSAW IN 46582 US 46582 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2015-04-17 |