MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,07,08 report with the FDA on 2004-01-09 for CTM ACCLM ULNA W HOLES STD RT 172246989 manufactured by Depuy Orthopaedics, Inc..
[340682]
Product was labeled incorrectly. Surgery was delayed one hour and the pt has a broken bone.
Patient Sequence No: 1, Text Type: D, B5
Report Number | 1818910-2004-00017 |
MDR Report Key | 505777 |
Report Source | 05,07,08 |
Date Received | 2004-01-09 |
Date of Report | 2003-12-10 |
Date of Event | 2003-12-10 |
Date Facility Aware | 2003-12-10 |
Report Date | 2003-12-10 |
Date Mfgr Received | 2003-12-10 |
Device Manufacturer Date | 2003-11-01 |
Date Added to Maude | 2004-01-13 |
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 | HANS KUSSEROW, MGR |
Manufacturer Street | 700 ORTHOPAEDIC DR |
Manufacturer City | WARSAW IN 465810988 |
Manufacturer Country | US |
Manufacturer Postal | 465810988 |
Manufacturer Phone | 5743727416 |
Manufacturer G1 | DEPUY ORTHOPAEDICS, INC. |
Manufacturer Street | 700 ORTHOPAEDIC DR |
Manufacturer City | WARSAW IN 46581098 |
Manufacturer Country | US |
Manufacturer Postal Code | 46581 0988 |
Single Use | 3 |
Remedial Action | OT |
Previous Use Code | 3 |
Removal Correction Number | NA |
Event Type | 3 |
Type of Report | 3 |
Brand Name | CTM ACCLM ULNA W HOLES STD RT |
Generic Name | EXTREMITIES |
Product Code | KWJ |
Date Received | 2004-01-09 |
Model Number | NA |
Catalog Number | 172246989 |
Lot Number | X5BFB1000 |
ID Number | NA |
Operator | HEALTH PROFESSIONAL |
Device Availability | Y |
Device Age | UNKNOWN |
Device Eval'ed by Mfgr | R |
Implant Flag | Y |
Date Removed | A |
Device Sequence No | 1 |
Device Event Key | 494644 |
Manufacturer | DEPUY ORTHOPAEDICS, INC. |
Manufacturer Address | 700 ORTHOPAEDIC DR. WARSAW IN 465810988 US |
Baseline Brand Name | CTM ACCLM ULNA W HOLES STD RT |
Baseline Generic Name | CUSTOMER ELBOW |
Baseline Model No | NA |
Baseline Catalog No | 172246989 |
Baseline ID | NA |
Baseline Device Family | CUSTOM ACCLAIM ULNA |
Baseline Shelf Life Contained | N |
Baseline Shelf Life [Months] | NA |
Baseline PMA Flag | N |
Baseline 510K PMN | N |
Baseline Preamendment | N |
Baseline Transitional | N |
510k Exempt | Y |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 1. Required No Informationntervention | 2004-01-09 |