MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2018-09-28 for EXTRACTION HOOK 242203000 manufactured by Depuy Orthopaedics Inc Us 1818910.
[122043089]
(b)(4). If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10
[122043090]
It was reported that the hook extractor broke during use.
Patient Sequence No: 1, Text Type: D, B5
[131011183]
Product complaint # (b)(4). Investigation summary: no device was received for examination, but the reported event of device breakage can be confirmed based on the submitted photographs of the device. Depuy considers the investigation closed. Should additional information be received, the information will be reviewed and the investigation will be re-opened as necessary. If information is obtained that was not available for the initial medwatch , a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10
[133860606]
Product complaint # : (b)(4). If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1818910-2018-70799 |
| MDR Report Key | 7918730 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2018-09-28 |
| Date of Report | 2018-09-11 |
| Date of Event | 2018-09-11 |
| Date Mfgr Received | 2018-12-17 |
| Device Manufacturer Date | 2015-07-16 |
| Date Added to Maude | 2018-09-28 |
| 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. KARA DITTY-BOVARD |
| Manufacturer Street | 1210 WARD AVENUE |
| Manufacturer City | WEST CHESTER IN 193800988 |
| Manufacturer Country | US |
| Manufacturer Postal | 193800988 |
| Manufacturer Phone | 6103142063 |
| Manufacturer G1 | DEPUY ORTHOPAEDICS, INC. 1818910 |
| Manufacturer Street | 700 ORTHOPAEDIC DR. |
| Manufacturer City | WARSAW IN 465810988 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 465810988 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | EXTRACTION HOOK |
| Generic Name | HIP INSTRUMENTS : EXTRACTION INSTRUMENTS |
| Product Code | KIK |
| Date Received | 2018-09-28 |
| Returned To Mfg | 2018-12-17 |
| Catalog Number | 242203000 |
| Lot Number | VZ13930 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DEPUY ORTHOPAEDICS INC US 1818910 |
| Manufacturer Address | 700 ORTHOPAEDIC DRIVE WARSAW IN 465810988 US 465810988 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-09-28 |