MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor report with the FDA on 2017-06-06 for LINEAR STRAIGHT BROACH HANDLE 803-03-059 T11824 manufactured by Greatbatch Medical.
[76746617]
The complaint sample was not returned to greatbatch for evaluation. Thus, an inspection could not be performed by greatbatch to confirm the reported event. The lot number was also not reported to greatbatch. The cause of the reported event is unknown as the complaint sample was not returned to the distributor to send to greatbatch. Report source distributor, (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[76746618]
It was reported during an unknown procedure that the broach handle broke while the surgeon was trying to insert the broach trial into the femur. The procedure was not completed as intended, however the device was not returned for investigation and no further information was provided with regard to completion of the surgery. No known adverse events were reported as a result of the malfunction.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3004976965-2017-00065 |
| MDR Report Key | 6614463 |
| Report Source | DISTRIBUTOR |
| Date Received | 2017-06-06 |
| Date of Report | 2017-05-12 |
| Date of Event | 2016-10-31 |
| Date Mfgr Received | 2017-05-12 |
| Date Added to Maude | 2017-06-06 |
| 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. TONY SINGH |
| Manufacturer Street | 4545 KROEMER ROAD |
| Manufacturer City | FORT WAYNE IN 46818 |
| Manufacturer Country | US |
| Manufacturer Postal | 46818 |
| Manufacturer Phone | 2607557466 |
| Manufacturer G1 | GREATBATCH MEDICAL |
| Manufacturer Street | 4545 KROEMER ROAD |
| Manufacturer City | FORT WAYNE IN 46818 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 46818 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LINEAR STRAIGHT BROACH HANDLE |
| Generic Name | BROACH HANDLE |
| Product Code | HTR |
| Date Received | 2017-06-06 |
| Model Number | 803-03-059 |
| Catalog Number | T11824 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | GREATBATCH MEDICAL |
| Manufacturer Address | 4545 KROEMER ROAD FORT WAYNE IN 46818 US 46818 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-06-06 |