BEUDAMED
    FDA Adverse Event Other Summary report: N

    DEPUY/JJ MOSS MIAMI HARDWARE

    MDR report key: 981231 · Received October 1, 2007

    Report

    Report Number
    MW4004302
    Event Type
    Other
    Date Received
    October 1, 2007
    Date of Event
    August 9, 2007
    Report Date
    August 28, 2007
    Manufacturer
    DEPUY/JJ
    Product Code
    KWQ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING PROCEDURE, WHEN ATTEMPTING TO REMOVE HARDWARE, SCREW TOP BROKE OFF. THIS WAS RETRIEVED FROM THE PT. PT WILL RETURN TO OR IN ONE WEEK TO REMOVE HARDWARE AND COMPLETE ORIGINALLY SCHEDULED PROCEDURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DEPUY/JJ MOSS MIAMI HARDWARE NONE KWQ DEPUY/JJ * *

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Other