MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2015-09-04 for SSI INSERTER N/A SSI002707 manufactured by Biomet Orthopedics.
[24997024]
Current information is insufficient to permit a conclusion as to the cause of the event.
Patient Sequence No: 1, Text Type: N, H10
[24997025]
It was reported patient underwent an initial hip procedure on (b)(6) 2015. During the procedure, a g7 ssi curved impactor fractured. A piece of the fractured inserter fell in the patient and was removed. There was a slight delay. No further information has been provided.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0001825034-2015-03867 |
| MDR Report Key | 5056011 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2015-09-04 |
| Date of Report | 2015-08-17 |
| Date of Event | 2015-08-17 |
| Date Mfgr Received | 2015-08-17 |
| Device Manufacturer Date | 2015-07-15 |
| Date Added to Maude | 2015-09-04 |
| 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 | 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 | SSI INSERTER |
| Generic Name | INSTRUMENT, HIP |
| Product Code | LKD |
| Date Received | 2015-09-04 |
| Model Number | N/A |
| Catalog Number | SSI002707 |
| Lot Number | RDWO41557 |
| ID Number | N/A |
| Operator | PHYSICIAN |
| Device Availability | Y |
| 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 | 2015-09-04 |