MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2019-02-21 for SHAFT FOR TREPHINE ATTACHMENTS 03.111.030 manufactured by Wrights Lane Synthes Usa Products Llc.
[136893497]
Part returned. The device was received, the investigation could not be completed, and no conclusion could be drawn, as product is entering the complaint system. The investigation could not be completed; no conclusion could be drawn, as no product was received. A review of the device history records has been requested. Device was used for treatment, not diagnosis. 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
[136893498]
It was reported that on an (b)(6) 2019, patient underwent bone graft, a shaft for trephine attachment broke and a trephine attachment may be stripped. A curette was used instead. Fragments were generated and was removed easily without additional intervention. There was no surgical delay. Procedure was completed successfully. There was no patient consequence. Concomitant medical products: unknown handle (part # unknown, lot # unknown, quantity 1). This complaint involves one (1) device this report is 1 of 1 for (b)(4).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2939274-2019-56592 |
| MDR Report Key | 8360082 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2019-02-21 |
| Date of Report | 2019-01-28 |
| Date of Event | 2019-01-28 |
| Date Mfgr Received | 2019-03-15 |
| Device Manufacturer Date | 2018-11-20 |
| Date Added to Maude | 2019-02-21 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | KARA DITTY-BOVARD |
| Manufacturer Street | 1302 WRIGHTS LANE EAST |
| Manufacturer City | WEST CHESTER PA 19380 |
| Manufacturer Country | US |
| Manufacturer Postal | 19380 |
| Manufacturer Phone | 6103142063 |
| Manufacturer G1 | WERK BETTLACH (CH) |
| Manufacturer Street | MURACHERSTRASSE 3 |
| Manufacturer City | BETTLACH 2544 |
| Manufacturer Country | SZ |
| Manufacturer Postal Code | 2544 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SHAFT FOR TREPHINE ATTACHMENTS |
| Generic Name | TREPHINE |
| Product Code | HWK |
| Date Received | 2019-02-21 |
| Returned To Mfg | 2019-02-07 |
| Model Number | 03.111.030 |
| Catalog Number | 03.111.030 |
| Lot Number | 1L23697 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | WRIGHTS LANE SYNTHES USA PRODUCTS LLC |
| Manufacturer Address | 1302 WRIGHTS LANE EAST WEST CHESTER PA 19380 US 19380 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-02-21 |