IPS 60-500-01-09

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-02-18 for IPS 60-500-01-09 manufactured by Kls Manufacturing.

Event Text Entries

[136455570] An investigation was performed on the basis of complaint statistics as no device was returned for evaluation. The complaint percentage was calculated, and it is determined that the complaint percentage falls within the design risk limits. During the investigation the product lot number identified was reviewed in the device history records. The dhr review showed no discrepancies or anomalies. The failure root cause cannot be determined due to no device being returned. If further information is obtained that might add value to the contents of the investigation report, an additional follow-up report will be submitted. Multiple mdr reports were filed for this event, please see associated report: mdr: 3014483751-2018-00001.
Patient Sequence No: 1, Text Type: N, H10


[136455571] It was reported that a splint deformed and cracked during the sterilization process. Discovered upon opening in the sterile field. A delay of 30 minutes was observed to get back-up product to complete the procedure.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number9610905-2018-00358
MDR Report Key8347626
Date Received2019-02-18
Date of Report2019-02-01
Date of Event2018-11-28
Date Facility Aware2019-02-01
Report Date2019-02-01
Date Reported to Mfgr2019-02-01
Date Mfgr Received2019-02-01
Date Added to Maude2019-02-18
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. JENNIFER DAMATO
Manufacturer StreetP.O. BOX 16369
Manufacturer CityJACKSONVILLE FL 32245
Manufacturer CountryUS
Manufacturer Postal32245
Manufacturer Phone9046417746
Manufacturer G1KLS MARTIN L.P.
Manufacturer StreetP.O. BOX 16369
Manufacturer CityJACKSONVILLE FL 32245
Manufacturer CountryUS
Manufacturer Postal Code32245
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameIPS
Generic NameSPLINT
Product CodeKMY
Date Received2019-02-18
Model Number60-500-01-09
Lot Number8000002693
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerKLS MANUFACTURING
Manufacturer Address11228 ST JOHNS INDUSTRIAL PKWY JACKSONVILLE 32246 US 32246


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2019-02-18

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