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Device Problem Device-Device Incompatibility (2919)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 05/25/2021
Event Type  malfunction  
Manufacturer Narrative
Pma/510k: this report is for an unknown plate/unknown lot. Part and lot number are unknown; udi number is unknown. Complainant part is not expected to be returned for manufacturer review/investigation. Without a lot number the device history records review could not be completed. Product was not returned. Based on the information available, it has been determined that no corrective and/or preventative action is proposed. This complaint will be accounted for and monitored via post market surveillance activities. If additional information is made available, the investigation will be updated as applicable. Device was used for treatment, not diagnosis. If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Event Description
Device report from (b)(6) reports an event as follows: it was reported that on (b)(6) 2021 that the patient underwent a removal surgery of a plate and screws. Before use, the operating surgeon and staff were aware of the wear of the hexagonal part of the screwdriver shaft. At the discretion of the surgeon, the screwdriver was used and removal was attempted. The screwdriver and the screws did not engage properly so another screwdriver was used to remove screws. There were several screws that were stuck to the plate or bone and became difficult to remove. Only the plate was removed using a removal device and several screws remained in the body. The surgery was completed successfully with over 30 minutes delay. This report is for one (1) unknown plate. This is report 3 of 3 for (b)(4).
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Brand NameUNK - PLATES
Type of DevicePLATE, FIXATION ,BONE   
Manufacturer (Section D)
eimattstrasse 3
oberdorf 4436
SZ 4436
Manufacturer Contact
kara ditty-bovard
1302 wright lane east
west chester, PA 19380
MDR Report Key12052715
MDR Text Key268138934
Report Number8030965-2021-05259
Device Sequence Number1
Product Code HRS
Combination Product (y/n)N
Reporter Country CodeJA
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Reporter Occupation
Type of Report Initial
Report Date 05/28/2021
1 Device was Involved in the Event
0 Patients were Involved in the Event:
Date FDA Received06/23/2021
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received05/28/2021
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device?
Type of Device Usage Unkown