BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    OFFSET CUP IMPACTOR

    MDR report key: 5353681 · Received January 8, 2016

    Report

    Report Number
    3004976965-2015-00035
    Event Type
    Malfunction
    Date Received
    January 8, 2016
    Date of Event
    February 9, 2015
    Report Date
    May 14, 2016
    Manufacturer
    GREATBATCH MEDICAL
    Product Code
    HWA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE WAS NOT RETURNED TO GREATBATCH MEDICAL FOR EVALUATION SO THE REPORTED EVENT CANNOT BE CONFIRMED. A PROCESS REVIEW WAS PERFORMED AND NO DISCREPANCIES WERE FOUND. THE INITIAL INVESTIGATION WAS COMPLETED BY THE CUSTOMER (SMITH & NEPHEW), AND THEY COULD NOT DETERMINE A SPECIFIC CAUSE OF THE FAILURE. NO FURTHER INVESTIGATION REQUIRED. COMPLAINT INFORMATION WAS PROVIDED BY SMITH AND NEPHEW. NOT RETURNED TO GREATBATCH.

    Additional Manufacturer Narrative · 1

    GREATBATCH MEDICAL IS NOT THE LEGAL MANUFACTURER OF THE DEVICE INVOLVED IN THIS INCIDENT.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE RATCHET BROKE AND THE DOCTOR HAD TO HOLD IT IN PLACE WHILE INSERTING CUP. NO ADVERSE EVENTS REPORTED AS A RESULT OF THE MALFUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    12067 OFFSET CUP IMPACTOR CUP IMPACTOR HWA GREATBATCH MEDICAL OR71368569 13LM13144

    Patients

    Seq Age Sex Outcome Treatment
    1