BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    REVOLUTION CEMENT GUN

    MDR report key: 3830608 · Received May 23, 2014

    Report

    Report Number
    0001811755-2014-01893
    Event Type
    Malfunction
    Date Received
    May 23, 2014
    Date of Event
    May 1, 2014
    Report Date
    May 1, 2014
    Manufacturer
    STRYKER INSTRUMENTS-KALAMAZOO
    Product Code
    JDZ
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    UPON VISUAL INSPECTION, THE RAM BUSHINGS WERE FOUND TO BE IN NEED OF REPLACEMENT. THE DEVICE WAS REPAIRED AND RETURNED TO THE USER FACILITY.

    Additional Manufacturer Narrative · 1

    A FOLLOW UP REPORT WILL BE FILED AFTER THE QUALITY INVESTIGATION HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT AFTER REPAIR AT THE WEST DISTRIBUTION CENTER (STRYKER (B)(4)) THE REVOLUTIN CEMENT GUN WAS PRODUCING METAL SHAVINGS. IT WAS REPORTED THAT THERE WAS NO ASSOCIATED PROCEDURE. NO PATIENT INVOLVEMENT, NO MEDICAL INTERVENTION AND NO ADVERSE CONSEQUENCES WERE REPORTED WITH THIS EVENT.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT AFTER REPAIR AT THE DISTRIBUTION CENTER ((B)(4)) THE REVOLUTION CEMENT GUN WAS PRODUCING METAL SHAVINGS. IT WAS REPORTED THAT THERE WAS NO ASSOCIATED PROCEDURE. NO PATIENT INVOLVEMENT, NO MEDICAL INTERVENTION AND NO ADVERSE CONSEQUENCES WERE REPORTED WITH THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    308259 REVOLUTION CEMENT GUN MIXER, CEMENT, FOR CLINICAL USE JDZ STRYKER INSTRUMENTS-KALAMAZOO

    Patients

    Seq Age Sex Outcome Treatment
    1