MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-04-26 for CBS 4.0 COUNTERSINK, CANNULATED, 15MM STOP, AO N/A 503004352 manufactured by Zimmer Gmbh.
[107196137]
The manufacturer did not receive the device yet, however it is indicated by complainant that it will be returned for investigation. The manufacturer did not receive x-rays, or other source documents for review. As no lot number was provided, the device history records could not be reviewed. An e-mail requesting the following additional information was sent on april 05, 2018 to the appropriate representatives. Lot number of the instrument. Details of patient involved in the surgery. How many times was the instrument used? 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).
Patient Sequence No: 1, Text Type: N, H10
[107196138]
It was reported that during a surgery the cbs 4. 0 countersink, cannulated, 15mm stop, ao fractured and the surgery was completed by another similar device with a delay of 5 min. It was also reported that no broken pieces remained inside patient. Note: 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 | 0009613350-2018-00484 |
| MDR Report Key | 7464246 |
| Date Received | 2018-04-26 |
| Date of Report | 2018-09-27 |
| Date of Event | 2017-10-06 |
| Date Mfgr Received | 2018-09-18 |
| Date Added to Maude | 2018-04-26 |
| 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 | 2018-04-26 |
| Model Number | N/A |
| Catalog Number | 503004352 |
| Lot Number | UNKNOWN |
| ID Number | UNKNOWN |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| 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 | 1. Other | 2018-04-26 |