MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2016-12-16 for BONE ELEVATOR 17MM WI.240MM FK171R manufactured by Aesculap Ag.
[62960893]
(b)(4). Manufacturing site evaluation: evaluation on-going.
Patient Sequence No: 1, Text Type: N, H10
[62960894]
Country of complaint: (b)(6). During a knee surgery the bone elevator device broke.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2916714-2016-01054 |
| MDR Report Key | 6181913 |
| Date Received | 2016-12-16 |
| Date of Report | 2017-09-20 |
| Date of Event | 2016-11-18 |
| Date Facility Aware | 2016-12-09 |
| Date Mfgr Received | 2016-11-24 |
| Device Manufacturer Date | 2016-08-16 |
| Date Added to Maude | 2016-12-16 |
| 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. NICOLE BROYLES |
| Manufacturer Street | 615 LAMBERT POINTE DRIVE |
| Manufacturer City | HAZELWOOD MO 63042 |
| Manufacturer Country | US |
| Manufacturer Postal | 63042 |
| Manufacturer Phone | 3145515988 |
| Manufacturer G1 | AESCULAP AG |
| Manufacturer Street | PO BOX 40 |
| Manufacturer City | TUTTLINGEN, 78501 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 78501 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | BONE ELEVATOR 17MM WI.240MM |
| Generic Name | GENERAL SURGICAL INSTRUMENTS |
| Product Code | GEG |
| Date Received | 2016-12-16 |
| Returned To Mfg | 2016-11-30 |
| Model Number | FK171R |
| Catalog Number | FK171R |
| Lot Number | 4507729243 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | 4 MO |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | AESCULAP AG |
| Manufacturer Address | PO BOX 40 TUTTLINGEN, 78501 GM 78501 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2016-12-16 |