BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    11CM ANGLE ATTACHMENT

    MDR report key: 4153413 · Received October 8, 2014

    Report

    Report Number
    1045834-2014-13561
    Event Type
    Malfunction
    Date Received
    October 8, 2014
    Report Date
    January 8, 2013
    Manufacturer
    DEPUY SYNTHES POWER TOOLS
    Product Code
    HBC
    PMA / PMN Number
    PK011444
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SZ
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    SYNTHES IS SUBMITTING THIS REPORT AS A RESULT OF REMEDIATION ACTIVITIES RELATED TO SYNTHES OUS SERVICE AND REPAIR FILES LEGACY REVIEW/REMEDIATION PROTOCOL-COMPLAINT HANDLING AND MDR REPORTING. BLANK FIELDS ON THIS FORM INDICATE THE INFORMATION IS UNKNOWN, UNAVAILABLE OR UNCHANGED. DEVICE LISTED IN THIS REPORT IS USED FOR TREATMENT, NOT DIAGNOSIS. ANY ADDITIONAL INFORMATION RECEIVED REGARDING THIS EVENT AFTER FILING THIS REPORT SHALL BE FILED ON A SUPPLEMENTAL MDR. DURING PRE-REPAIR ASSESSMENT PERFORMED BY A TECHNICIAN, FUNCTIONAL TESTING WAS PERFORMED AND REVEALED THE DEVICE WAS DAMAGED. THIS WAS ATTRIBUTED TO NORMAL WEAR. DEVICE WAS REPAIRED AND RETURNED TO THE CUSTOMER.

    Description of Event or Problem · 1

    CUSTOMER REPORTED THAT THE SHAFTS WERE BROKEN AND IT PREVENTED THE CUTTING BURR FROM THE PROPERLY ATTACHING AND DETACHING. DURING THE SERVICE, TECHNICIAN FOUND THAT THE THE BEARING WAS DEFECTIVE, THE DRIVE SHAFT WAS SEVERELY WORN, AND THE TOOL LOCK WAS DAMAGED.THIS IS REPORT 1 OF 1 FOR COMPLAINT (B)(4.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    630800 11CM ANGLE ATTACHMENT MOTOR, DRILL, ELECTRIC HBC DEPUY SYNTHES POWER TOOLS

    Patients

    Seq Age Sex Outcome Treatment
    1