FDA Adverse Event Malfunction Summary report: N

BOLT CUTTING HEAD Ø5 LONG CUTTING-H 2 F/

MDR report key: 3191892 · Received June 26, 2013

Report

Report Number
8030965-2013-03343
Event Type
Malfunction
Date Received
June 26, 2013
Report Date
September 8, 2011
Manufacturer
SYNTHES GMBH
Product Code
HXZ
PMA / PMN Number
EXEMPT
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CE
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

SYNTHES IS SUBMITTING THIS REPORT AS A RESULT OF REMEDIATION ACTIVITIES RELATED TO FDA WARNING LETTER DATED FEBRUARY 2012. DEVICE(S) LISTED IN THIS REPORT IS (ARE) USED FOR TREATMENT, NOT DIAGNOSIS. ANY ADDITIONAL INFORMATION RECEIVED REGARDING THIS EVENT AFTER FILING THIS REPORT SHALL BE FILED ON A SUPPLEMENTAL MDR. DEVICE MANUFACTURE DATE WAS 03/04/2004. THE DEVICE HISTORY RECORDS WERE REVIEWED. THE MANUFACTURING DOCUMENTS WERE REVIEWED AND NO COMPLAINT RELATED ISSUES WERE FOUND. (B)(6). PLACEHOLDER.

Additional Manufacturer Narrative · 1

SYNTHES IS SUBMITTING THIS REPORT AS A RESULT OF REMEDIATION ACTIVITIES RELATED TO FDA WARNING LETTER DATED FEBRUARY 2012. DEVICE(S) LISTED IN THIS REPORT IS (ARE) USED FOR TREATMENT, NOT DIAGNOSIS. ANY ADDITIONAL INFORMATION RECEIVED REGARDING THIS EVENT AFTER FILING THIS REPORT SHALL BE FILED ON A SUPPLEMENTAL MDR. PRO CODES: HTZ, FZT. A REVIEW OF THE DHR FOR THIS LOT HAS BEEN REQUESTED. THE ADDITIONAL EVALUATION VISUAL INSPECTION REVEALED THAT THE BOLT CUTTING HEAD IS BROKEN. OUR INVESTIGATION FOUND THAT A PIECE ON THE CUTTING HEADS BODY ON THE TIP BROKE OFF. THE HARDNESS AND DIMENSIONS WERE FOUND TO MEET OUR SPECIFICATIONS. WE ARE NOT ABLE TO RELIABLY DETERMINE A CAUSE FOR THE BREAKAGE. NO PRODUCT FAULT OR MATERIAL RELATED CONDITION WAS FOUND.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE BOLT CUTTING HEAD WAS BROKEN. THIS IS REPORT 2 OF 2 FOR COMPLAINT (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
290445 BOLT CUTTING HEAD Ø5 LONG CUTTING-H 2 F/ HXZ SYNTHES GMBH 1247924

Patients

Seq Age Sex Outcome Treatment
1