MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,07 report with the FDA on 1997-01-24 for EXETER CUP INTRODUCER 0930-3-000 manufactured by Howmedica Inc..
[43206]
The locking mechanism connecting handle and distal part is broken. There was no adverse consequence for the pt or delay in surgery or anesthesia time.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 8010096-1997-00003 |
| MDR Report Key | 65397 |
| Report Source | 01,07 |
| Date Received | 1997-01-24 |
| Date of Report | 1997-01-24 |
| Report Date | 1997-01-23 |
| Date Mfgr Received | 1996-12-20 |
| Date Added to Maude | 1997-01-30 |
| 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 | 0 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | EXETER CUP INTRODUCER |
| Generic Name | INSTRUMENT |
| Product Code | KIL |
| Date Received | 1997-01-24 |
| Model Number | NA |
| Catalog Number | 0930-3-000 |
| Lot Number | NA |
| ID Number | NA |
| Operator | OTHER |
| Device Availability | R |
| Device Age | UNKNOWN |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 65491 |
| Manufacturer | HOWMEDICA INC. |
| Manufacturer Address | 359 VETERANS BLVD RUTHERFORD NJ 07070 US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 1997-01-24 |