MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2020-03-27 for MOD SQUARE EXP 5.5 SI DRIVER 698341353 manufactured by Depuy Spine Inc.
| Report Number | 1526439-2020-00791 |
| MDR Report Key | 9888204 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2020-03-27 |
| Date of Report | 2020-01-29 |
| Date Mfgr Received | 2020-03-11 |
| Device Manufacturer Date | 2019-09-03 |
| Date Added to Maude | 2020-03-27 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | KARA DITTY-BOVARD |
| Manufacturer Street | 325 PARAMOUNT DRIVE |
| Manufacturer City | RAYNHAM MA 02767 |
| Manufacturer Country | US |
| Manufacturer Postal | 02767 |
| Manufacturer Phone | 6103142063 |
| Manufacturer G1 | BRIDGEWATER DISTRIBUTION |
| Manufacturer Street | 50 SCOTLAND BOULEVARD |
| Manufacturer City | BRIDGEWATER MA 02324 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 02324 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MOD SQUARE EXP 5.5 SI DRIVER |
| Generic Name | SCREWDRIVERES |
| Product Code | HXX |
| Date Received | 2020-03-27 |
| Returned To Mfg | 2020-03-04 |
| Model Number | 698341353 |
| Catalog Number | 698341353 |
| Lot Number | GM54969MT |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DEPUY SPINE INC |
| Manufacturer Address | 325 PARAMOUNT DRIVE RAYNHAM MA 02767 US 02767 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-03-27 |