BROCA ?1.5 C/TRAV C13/6 2AREST-CORT 03.505.075

MAUDE Adverse Event Report

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 2019-05-23 for BROCA ?1.5 C/TRAV C13/6 2AREST-CORT 03.505.075 manufactured by Oberdorf Synthes Produktions Gmbh.

Event Text Entries

[146088083] Additional pro code: dzj. The investigation could not be completed; no conclusion could be drawn, as no product was received. Based on the information available, it has been determined that no corrective and/or preventative action is proposed. This complaint will be accounted for and monitored via post market surveillance activities. If additional information is made available, the investigation will be updated as applicable. 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


[146088084] It was reported that on (b)(6) 2019, during an open reduction internal fixation (orif) of the mandible, a drill bit broke upon drilling. The broken fragment were retrieved from the patient's body and none remained. There was a surgical delay of about 60 minutes. There was no evidence of adverse consequences to the patient. This complaint involves one (1) broca drill bit. This is report 1 of 1 for (b)(4).
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number8030965-2019-64462
MDR Report Key8637509
Report SourceCOMPANY REPRESENTATIVE,FOREIG
Date Received2019-05-23
Date of Report2019-04-25
Date of Event2019-04-25
Date Mfgr Received2019-07-10
Date Added to Maude2019-05-23
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 ContactKARA DITTY-BOVARD
Manufacturer StreetEIMATTSTRASSE 3
Manufacturer CityOBERDORF 4436
Manufacturer CountrySZ
Manufacturer Postal4436
Manufacturer Phone6103142063
Manufacturer G1SYNTHES SELZACH
Manufacturer StreetBOHACKERWEG 5
Manufacturer CitySELZACH 2545
Manufacturer CountrySZ
Manufacturer Postal Code2545
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameBROCA ?1.5 C/TRAV C13/6 2AREST-CORT
Generic NameDRILL, BONE, POWERED
Product CodeDZI
Date Received2019-05-23
Model Number03.505.075
Catalog Number03.505.075
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerOBERDORF SYNTHES PRODUKTIONS GMBH
Manufacturer AddressEIMATTSTRASSE 3 OBERDORF 4436 SZ 4436


Patients

Patient NumberTreatmentOutcomeDate
10 2019-05-23

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