MAUDE MDR 6438621

MDR report key
6438621
Report number
8020045-2017-00011
Event key
0
Event type
3
Date received
2017-03-28
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MR. BURRHUS LANG
Address
ARCHENWEG 56 6020 INNSBRUCK INNSBRUCK, TIROL AU
Phone
512-512-512
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ZIMMERSTIMULATION ELECTRODELEONHARD LANG GMBHGXYSE0287 200 12070130-0641Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-03-2801. O

Event Narratives#

N

Patient 1

THE CUSTOMER DID NOT RETURN THE ENTIRE INVOLVED DEVICE BUT SENT US ONLY THE METAL WIRE HE HAD RECOVERED FROM ITS SURFACE. THE PIECE OF WIRE IS ABOUT 40MM OF LENGTH AND HAS A DIAMETER OF 0,39MM. THE INVESTIGATION REVEALED THAT THE WIRE MUST HAVE BEEN INTRODUCED INADVERTENTLY ONTO THE GEL SURFACE IN THE PRODUCTION MACHINE. THE ONLY CONCEIVABLE SOURCE IS A STEEL BRUSH USED AT A NEARBY PACKAGING MACHINE, ALTHOUGH THE DIAMETER OF ITS STRANDS APPEARS TO DIFFER IN DIAMETER. CORRECTIVE ACTION TO PREVENT RECURRENCE IS BEING DEVELOPED AND WILL BE IMPLEMENTED.

D

Patient 1

ON (B)(6) 2017, WE HAVE BEEN INFORMED ABOUT AN INCIDENT WITH ZIMMER STIMULATION ELECTRODES. DURING A THERAPY SESSION A PATIENT RECEIVED STIMULATION THROUGH A PAIR OF STIMULATION ELECTRODES. DURING THE TREATMENT, THE PATIENT STARTED TO FEEL PAIN. THE THERAPIST RESPONDED IMMEDIATELY, CHECKED THE ELECTRODES AND DISCOVERED AN APPROXIMATELY 40 MM LONG METAL STRAND. NO MEDICAL INTERVENTION WAS NECESSARY. NOR FURTHER DETAILS ON THE PATIENT AND THE PROCEDURE HAVE BEEN DISCLOSED.