MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-03-13 for GPSIII 30 W/ACDA JP N/A 800-1012 manufactured by Zimmer Biomet, Inc..
[138936676]
(b)(4). Lot number? The lot number cannot be confirmed, however, is likely one of 701805, 801851, 801854, 802306, or 802556. Customer has indicated that the product is in process of being returned to zimmer biomet for investigation. Once the investigation has been completed, a follow-up mdr will be submitted.
Patient Sequence No: 1, Text Type: N, H10
[138936677]
It was reported that during a procedure utilizing a platelet concentrate separator kit, the platelet rich plasma (prp) appeared paler than normal and, when attempting to inject, the surgeon was unable to use push the syringe plunger. No additional information is available.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0001825034-2019-01124 |
| MDR Report Key | 8417764 |
| Date Received | 2019-03-13 |
| Date of Report | 2019-04-29 |
| Date of Event | 2019-02-13 |
| Date Mfgr Received | 2019-04-02 |
| Date Added to Maude | 2019-03-13 |
| 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 BIOMET, INC. |
| Manufacturer Street | 56 E. BELL DRIVE |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 46582 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | N/A |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | GPSIII 30 W/ACDA JP |
| Generic Name | CENTRIFUGES |
| Product Code | KSS |
| Date Received | 2019-03-13 |
| Model Number | N/A |
| Catalog Number | 800-1012 |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ZIMMER BIOMET, INC. |
| Manufacturer Address | 56 E. BELL DRIVE WARSAW IN 46582 US 46582 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-03-13 |