DISTRACTION 50-347-05-09

MAUDE Adverse Event Report

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 2020-01-02 for DISTRACTION 50-347-05-09 manufactured by Karl Leibinger Medizintechnik Gmbh & Co. Kg.

Event Text Entries

[173276985] (b)(4). Possible lot numbers: 33169817, 33260716. An investigation was performed on the basis of complaint statistics as no device was returned for evaluation. The failure root cause cannot be determined due to the device not 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.
Patient Sequence No: 1, Text Type: N, H10


[173276986] It was reported the screws pulled out of the bone. Screws were removed.
Patient Sequence No: 1, Text Type: D, B5


[184947973] An investigation was performed on the basis of complaint statistics as no device was returned for evaluation. The failure root cause cannot be determined due to the device not 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. Manufacturing date: lot 33169817, date 05 july 2016; lot 33260716, date 29 june 2018.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number9610905-2019-00257
MDR Report Key9537647
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2020-01-02
Date of Report2019-12-18
Date of Event2019-12-18
Date Facility Aware2020-03-13
Report Date2019-12-18
Date Reported to Mfgr2019-12-18
Date Mfgr Received2020-03-13
Date Added to Maude2020-01-02
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 G1KARL LEIBINGER MEDIZINTECHNIK GMBH & CO. KG
Manufacturer StreetKOLBINGER STRASSE 10
Manufacturer CityMUEHLHEIM/DONAU, 78570
Manufacturer CountryGM
Manufacturer Postal Code78570
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameDISTRACTION
Generic NameDISTRACTION
Product CodeMQN
Date Received2020-01-02
Model Number50-347-05-09
Lot NumberSEE H10
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerKARL LEIBINGER MEDIZINTECHNIK GMBH & CO. KG
Manufacturer AddressKOLBINGER STRASSE 10 MUEHLHEIM/DONAU, 78570 GM 78570


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2020-01-02

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