BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TI CORTICAL SCREW QUICK-CONNECT DRILL

    MDR report key: 1940557 · Received December 21, 2010

    Report

    Report Number
    1822565-2010-01408
    Event Type
    Injury
    Date Received
    December 21, 2010
    Date of Event
    November 10, 2010
    Report Date
    November 30, 2010
    Manufacturer
    ZIMMER, INC.
    Product Code
    HTW
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    INFO WAS RECEIVED FROM A FOREIGN SOURCE WHO IS NOT REQUIRED TO COMPLETE FORM 3500A. THIS REPORT WILL BE AMENDED WHEN OUR INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE DRILL BIT WAS FRACTURED AND THE BROKEN PIECE WAS LEFT IN THE PT'S BODY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TI CORTICAL SCREW QUICK-CONNECT DRILL TRAUMA INSTRUMENT HTW ZIMMER, INC. 60505836

    Patients

    Seq Age Sex Outcome Treatment
    1 88 YR Other