BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CORE IMPACTION DRILL

    MDR report key: 3071525 · Received April 22, 2013

    Report

    Report Number
    0001811755-2013-00858
    Event Type
    Malfunction
    Date Received
    April 22, 2013
    Date of Event
    April 3, 2013
    Report Date
    April 3, 2013
    Manufacturer
    STRYKER INSTRUMENTS-KALAMAZOO
    Product Code
    DZJ
    PMA / PMN Number
    K040369
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ID, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    UPON DISASSEMBLY FOR VISUAL INSPECTION THE BUR WAS STUCK IN THE DRIVESHAFT.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING TESTING BUR BROKE INSIDE THE CORE IMPACTION DRILL. THERE WAS NO PATIENT INVOLVEMENT OR ADVERSE CONSEQUENCES TO THE USER REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    172789 CORE IMPACTION DRILL DRIVER, WIRE, AND BONE DRILL, DZJ STRYKER INSTRUMENTS-KALAMAZOO

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN BUR