MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,07 report with the FDA on 2007-11-29 for KINSA UNK 72200239 manufactured by Smith & Nephew Inc., Endoscopy Div..
[19961404]
The surgeon retracted insertion sleeve all the way back before hammering in the anchor. The anchor was fractured from hammering.
Patient Sequence No: 1, Text Type: D, B5
[20094651]
.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1219602-2007-00300 |
| MDR Report Key | 956947 |
| Report Source | 01,07 |
| Date Received | 2007-11-29 |
| Date of Report | 2007-11-26 |
| Date of Event | 2007-06-25 |
| Date Facility Aware | 2007-06-25 |
| Report Date | 2007-11-26 |
| Date Mfgr Received | 2007-11-16 |
| Date Added to Maude | 2008-02-29 |
| 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 | DONNA LANTEIGNE |
| Manufacturer Street | 150 MINUTEMAN RD |
| Manufacturer City | ANDOVER MA 01810 |
| Manufacturer Country | US |
| Manufacturer Postal | 01810 |
| Manufacturer Phone | 9787491576 |
| Manufacturer G1 | SMITH & NEPHEW INC., ENDOSCOPY DIV. |
| Manufacturer Street | 130 FORBES BLVD. |
| Manufacturer City | MANSFIELD MA 02048 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 02048 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | KINSA |
| Generic Name | KINSA SUTURE ANCHOR |
| Product Code | KGS |
| Date Received | 2007-11-29 |
| Model Number | UNK |
| Catalog Number | 72200239 |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | NA |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | B |
| Device Sequence No | 1 |
| Device Event Key | 953404 |
| Manufacturer | SMITH & NEPHEW INC., ENDOSCOPY DIV. |
| Manufacturer Address | MANSFIELD MA US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2007-11-29 |