BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AMIS BROACH HANDLE

    MDR report key: 1994338 · Received January 14, 2011

    Report

    Report Number
    3005180920-2010-00031
    Event Type
    Malfunction
    Date Received
    January 14, 2011
    Report Date
    January 12, 2011
    Manufacturer
    MEDACTA INTERNATIONAL, SA
    Product Code
    JDI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    UPON FAILURE ANALYSIS, THE AMIS BROACH HANDLE PIN WAS FOUND TO BE BROKEN. ON THE BASIS OF MEDACTA'S RISK ANALYSIS, THE FAILURE MODE IS LIKELY TO CAUSE PT HARM SINCE, IN CASE OF MALFUNCTIONING OF THE BROACH HANDLE A SECOND BROACH HANDLE IS ALWAYS AVAILABLE IN THE INSTRUMENTATION KIT, PERMITTING THE SURGEON TO COMPLETE THE SURGERY SUCCESSFULLY, AS HAPPENED IN THIS CASE. FROM THE DOCUMENT REVIEW OF THE LOT 085681 ((B)(4)), NO PARTICULAR ANOMALIES WERE FOUND RELATED TO THE PROBLEM HAD.

    Description of Event or Problem · 1

    THE MOBILE PIN OF THE BROACH HANDLE ((B)(4) - LOT. 085681) IS BROKEN. NO PT OR USER INVOLVED. THE SURGERY WAS COMPLETED SUCCESSFULLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AMIS BROACH HANDLE REUSABLE SURGICAL INSTRUMENT FOR HIP JDI MEDACTA INTERNATIONAL, SA NA 085681

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK