MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor report with the FDA on 2018-10-03 for IN SITU ROD BENDER, STRAIGHT (DIA. 3.8MM) 07.01773.002 manufactured by Zimmer Biomet Spine Inc..
[122504892]
Current information is insufficient to permit a valid conclusion about the cause of this event. A follow up report will be sent upon completion of the device evaluation.
Patient Sequence No: 1, Text Type: N, H10
[122504893]
It was reported that the tip of a rod bender was found to have broken off during a routine inspection. It is unknown how or when the device was being used when it broke.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3012447612-2018-00791 |
| MDR Report Key | 7930372 |
| Report Source | DISTRIBUTOR |
| Date Received | 2018-10-03 |
| Date of Report | 2019-01-21 |
| Date of Event | 2018-09-05 |
| Date Mfgr Received | 2019-01-16 |
| Device Manufacturer Date | 2014-06-26 |
| Date Added to Maude | 2018-10-03 |
| 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. ASHLEY MCPHERSON |
| Manufacturer Street | 10225 WESTMOOR DR. NA |
| Manufacturer City | WESTMINSTER CO 80021 |
| Manufacturer Country | US |
| Manufacturer Postal | 80021 |
| Manufacturer Phone | 3034437500 |
| Manufacturer G1 | ZIMMER BIOMET SPINE INC. |
| Manufacturer Street | 10225 WESTMOOR DR. NA |
| Manufacturer City | WESTMINSTER CO 80021 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 80021 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | IN SITU ROD BENDER, STRAIGHT (DIA. 3.8MM) |
| Generic Name | BENDER |
| Product Code | HXW |
| Date Received | 2018-10-03 |
| Returned To Mfg | 2018-09-13 |
| Model Number | NA |
| Catalog Number | 07.01773.002 |
| Lot Number | 62488146 |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ZIMMER BIOMET SPINE INC. |
| Manufacturer Address | 10225 WESTMOOR DR. NA WESTMINSTER CO 80021 US 80021 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-10-03 |