TWINFIX ULTRA PK 4.5MM W/2 UB -WHT &BL 72202595

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 2020-03-28 for TWINFIX ULTRA PK 4.5MM W/2 UB -WHT &BL 72202595 manufactured by Smith & Nephew, Inc..

Event Text Entries

[186231109] It was reported that during an achilles tendon repair surgery, the anchor slipped out and it can't screw-in. It is unknown if there was an available backup device or a significant delay during the procedure. No patient injury or other complications were reported. Results of investigation have concluded that unit threads were damaged (burnished and scalloped) which makes it a reportable event. All available information has been disclosed. If additional information should become available, a supplemental report will be submitted accordingly.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1219602-2020-00560
MDR Report Key9894923
Report SourceCOMPANY REPRESENTATIVE,FOREIG
Date Received2020-03-28
Date of Report2020-03-28
Date of Event2019-12-12
Date Mfgr Received2020-03-05
Device Manufacturer Date2019-01-11
Date Added to Maude2020-03-28
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 ContactHOLLY TOPPING
Manufacturer Street7000 WEST WILLIAM CANNON DRIVE
Manufacturer CityAUSTIN TX 78735
Manufacturer CountryUS
Manufacturer Postal78735
Manufacturer Phone5123913905
Manufacturer G1SMITH & NEPHEW, INC.
Manufacturer Street130 FORBES BOULEVARD
Manufacturer CityMANSFIELD MA 02048
Manufacturer CountryUS
Manufacturer Postal Code02048
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameTWINFIX ULTRA PK 4.5MM W/2 UB -WHT &BL
Generic NameFASTENER, FIXATION, NONDEGRADABLE, SOFT TISSUE
Product CodeMBI
Date Received2020-03-28
Returned To Mfg2020-03-04
Model Number72202595
Catalog Number72202595
Lot Number2025331
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerSMITH & NEPHEW, INC.
Manufacturer Address130 FORBES BOULEVARD MANSFIELD MA 02048 US 02048


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-28

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