MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-04-17 for IMPACTOR, 36 N/A 01.00209.114 manufactured by Zimmer Gmbh.
[105891220]
Concomitant medical products: item: impactor, 36 catalog #: 01. 00209. 114, lot #: 4501852854. The manufacturer did not receive x-rays, or other source documents for review. The manufacturer did not receive the device yet, however it is indicated by complainant that it will be returned for investigation. The device manufacturing quality records indicate that the released components met all requirements to perform as intended. 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. Zimmer biomet? S reference number of this file is (b)(4). The following reports are associated with this event: 0009613350 - 2018 - 00444. The actual device reported is not marketed in usa, but devices with similar characteristics (i. E 01. 00109. 808 impactor) are marketed in usa, and therefore this report was filed.
Patient Sequence No: 1, Text Type: N, H10
[105891221]
It was reported that during surgery an impactor, 36 had broken. It was also reported that the surgery was completed with another set of instruments and the surgery was delayed by 3 min. 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 | 0009613350-2018-00443 |
| MDR Report Key | 7436156 |
| Date Received | 2018-04-17 |
| Date of Report | 2018-08-03 |
| Date of Event | 2018-03-16 |
| Date Mfgr Received | 2018-07-12 |
| Device Manufacturer Date | 2007-09-21 |
| Date Added to Maude | 2018-04-17 |
| 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 | IMPACTOR, 36 |
| Generic Name | N/A |
| Product Code | HSZ |
| Date Received | 2018-04-17 |
| Returned To Mfg | 2018-05-09 |
| Model Number | N/A |
| Catalog Number | 01.00209.114 |
| Lot Number | 4501773001 |
| ID Number | 00889024385573 |
| 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 | 2018-04-17 |