BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AMIS BROACH HANDLE

    MDR report key: 2111021 · Received May 5, 2011

    Report

    Report Number
    3005180920-2011-00024
    Event Type
    Malfunction
    Date Received
    May 5, 2011
    Date of Event
    April 19, 2011
    Report Date
    May 5, 2011
    Manufacturer
    MEDACTA INTERNATIONAL, SA
    Product Code
    JDI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    ON THE BASIS OF MEDACTA'S RISK ANALYSIS, THE FAILURE MODE IS UNLIKELY TO CAUSE PATIENT 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 INVOLVED (084700) NO PARTICULAR ANOMALIES WERE FOUND RELATED TO THE PROBLEM OCCURRED.

    Description of Event or Problem · 1

    THE MOBILE PEG OF THE HANDLE 01.15.10.0131 WAS BROKEN. NO PATIENT 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 084700

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK