MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2015-12-28 for COUNTERSINK, CANNULATED AUTOFIX 2.0/2.5 9071003 manufactured by Stryker Gmbh.
[35017233]
(b)(4). Device will not be returned. If additional information becomes available it will be provided on a supplemental report. The device is not available to stryker.
Patient Sequence No: 1, Text Type: N, H10
[35017234]
T-7 driver and countersink broke during surgery.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0008031020-2015-00676 |
| MDR Report Key | 5328833 |
| Date Received | 2015-12-28 |
| Date of Report | 2014-05-28 |
| Date of Event | 2014-05-28 |
| Date Mfgr Received | 2014-05-28 |
| Date Added to Maude | 2015-12-28 |
| 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 | MR. ANNA JUSINSKI |
| Manufacturer Street | 325 CORPORATE DRIVE |
| Manufacturer City | MAHWAH NJ 07430 |
| Manufacturer Country | US |
| Manufacturer Postal | 07430 |
| Manufacturer Phone | 2018315000 |
| Manufacturer G1 | STRYKER GMBH |
| Manufacturer Street | BOHNACKERWEG 1 POSTFACH |
| Manufacturer City | SELZACH 2545 |
| Manufacturer Country | CH |
| Manufacturer Postal Code | 2545 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | COUNTERSINK, CANNULATED AUTOFIX 2.0/2.5 |
| Generic Name | ORTHOPEDIC MANUAL SURGICAL INSTRUMENT |
| Product Code | HWW |
| Date Received | 2015-12-28 |
| Catalog Number | 9071003 |
| Lot Number | V0498 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | STRYKER GMBH |
| Manufacturer Address | BOHNACKERWEG 1 POSTFACH SELZACH 2545 CH 2545 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2015-12-28 |