ANT BROACH HANDLE - R 2598-07-360 259807360

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 2020-03-12 for ANT BROACH HANDLE - R 2598-07-360 259807360 manufactured by Depuy Orthopaedics Inc Us.

Event Text Entries

[183152268] Product complaint # (b)(4). 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


[183152269] It was reported that the patient had a right total hip. During assembly of the instruments after the surgery, it was noticed the offset broach handle was broken. A piece was missing from the locking junction in the middle of the handle. It was unknown where the piece was, or if the piece was left in the patient. No surgical delay.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1818910-2020-07609
MDR Report Key9824105
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2020-03-12
Date of Report2020-02-25
Date of Event2020-02-25
Date Mfgr Received2020-03-27
Device Manufacturer Date2008-01-15
Date Added to Maude2020-03-12
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. KARA DITTY-BOVARD
Manufacturer Street700 ORTHOPAEDIC DRIVE
Manufacturer CityWARSAW IN 465810988
Manufacturer CountryUS
Manufacturer Postal465810988
Manufacturer Phone6107428552
Manufacturer G1DEPUY ORTHOPAEDICS INC. 1818910
Manufacturer Street700 ORTHOPEDICS DR.
Manufacturer CityWARSAW IN 465810988
Manufacturer CountryUS
Manufacturer Postal Code465810988
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameANT BROACH HANDLE - R
Generic NameHIP INSTRUMENTS : HANDLES
Product CodeHTQ
Date Received2020-03-12
Returned To Mfg2020-03-10
Model Number2598-07-360
Catalog Number259807360
Lot NumberB0108
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerDEPUY ORTHOPAEDICS INC US
Manufacturer Address700 ORTHOPAEDIC DRIVE WARSAW IN 465810988 US 465810988


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-12

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