MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-12-15 for CBS 4.0 COUNTERSINK, CANNULATED, 15MM STOP, AO N/A 503004352 manufactured by Zimmer Gmbh.
[95382283]
Photographs were received and will be reviewed as part of ongoing investigation. The device was received, the investigation is pending. The device history records were reviewed and found to be conforming. Additional information has been requested and is currently not available. A cause for this specific event cannot be ascertained from the information provided. As soon as supplemental information becomes available an updated report will be submitted. (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[95382284]
It was reported that during surgery on (b)(6) 2017 the tip of the reamer: cbs 4. 0 countersink, cannulated, 15mm stop, ao fractured. The surgery was completed with another reamer. Notes: the implantation and explantation dates are left empty as the device involved in this complaint is an instrument. Hence, no expiration date is captured, for the same reason.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0009613350-2017-01773 |
| MDR Report Key | 7120339 |
| Date Received | 2017-12-15 |
| Date of Report | 2018-05-30 |
| Date of Event | 2017-09-11 |
| Date Mfgr Received | 2018-05-18 |
| Device Manufacturer Date | 2014-11-10 |
| Date Added to Maude | 2017-12-15 |
| 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. CHRISTINA ARNT |
| Manufacturer Street | 56 E. BELL DR. |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal | 46582 |
| Manufacturer Phone | 5745273773 |
| Manufacturer G1 | ZIMMER GMBH |
| Manufacturer Street | SULZER ALLEE 8 SULZER INDUSTRIE PARK |
| Manufacturer City | WINTERTHUR 8404 |
| Manufacturer Country | SZ |
| Manufacturer Postal Code | 8404 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | N/A |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | CBS 4.0 COUNTERSINK, CANNULATED, 15MM STOP, AO |
| Generic Name | N/A |
| Product Code | HWW |
| Date Received | 2017-12-15 |
| Returned To Mfg | 2017-10-11 |
| Model Number | N/A |
| Catalog Number | 503004352 |
| Lot Number | 14935 |
| ID Number | UNKNOWN |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ZIMMER GMBH |
| Manufacturer Address | SULZER ALLEE 8 SULZER INDUSTRIE PARK WINTERTHUR 8404 SZ 8404 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-12-15 |