FDA Adverse Event Malfunction Summary report: Y

REVOLUTION CEMENT GUN

MDR report key: 16261793 · Received January 29, 2023

Report

Report Number
3015967359-2023-00138
Event Type
Malfunction
Date Received
January 29, 2023
Date of Event
December 31, 2022
Report Date
July 27, 2023
Manufacturer
STRYKER INSTRUMENTS-A DIVISION OF STRYKER CORP
Product Code
JDZ
UDI-DI
04546540437037
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MI, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

THIS RECORD IS A CONSOLIDATION OF RECORDS SUMMARIZED AS A PART OF THE FDA VOLUNTARY MALFUNCTION SUMMARY REPORTING PROGRAM. REPORTED EVENTS: 1 EVENT WAS REPORTED FOR THIS QUARTER. PRODUCT RETURN STATUS: 1 DEVICE INVESTIGATION TYPE HAS NOT YET BEEN DETERMINED. ADDITIONAL INFORMATION: 1 DEVICE WAS NOT LABELED FOR SINGLE-USE; 1 DEVICE WAS NOT REPROCESSED OR REUSED.

Additional Manufacturer Narrative · 0

THIS RECORD IS A CONSOLIDATION OF RECORDS SUMMARIZED AS A PART OF THE FDA VOLUNTARY MALFUNCTION SUMMARY REPORTING PROGRAM. SUPPLEMENTAL RATIONALE 1 PREVIOUSLY REPORTED EVENT IS INCLUDED IN THIS FOLLOW-UP RECORD. PRODUCT RETURN STATUS 1 DEVICE WAS RECEIVED.

Description of Event or Problem · 0

THIS REPORT SUMMARIZES 1 MALFUNCTION EVENT IN WHICH THE DEVICE DISASSEMBLED AND WAS SHEDDING METAL DEBRIS. EVENT HAD NO PATIENT INVOLVEMENT; NO PATIENT IMPACT.

Description of Event or Problem · 0

THIS REPORT SUMMARIZES 1 MALFUNCTION EVENT IN WHICH THE DEVICE DISASSEMBLED AND WAS SHEDDING METAL DEBRIS. 1 EVENT HAD NO PATIENT INVOLVEMENT; NO PATIENT IMPACT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
16006 REVOLUTION CEMENT GUN MIXER, CEMENT, FOR CLINICAL USE JDZ STRYKER INSTRUMENTS-A DIVISION OF STRYKER CORP 0606600000 04546540437037

Patients

Seq Age Sex Outcome Treatment
1 Unknown