MAUDE Adverse Event Report: AESCULAP AG HI-LINE CRANIOTOME HDPC W/O DURAGUARD; POWER SYSTEMS

Model Number	GB520R
Medical Device Problem Code	Mechanical Problem (1384)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/23/2021
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported to aesculap ag that a hi-line craniotome hdpc w/o duraguard (part # gb520r) was used during a procedure performed on (b)(6) 2021.According to the complainant, the power system milling cutter handle (sn:(b)(4)) failed, and the small steel ball fell off during use.The complaint device has not been returned to the manufacturer for evaluation.No patient complications were reported as a result of the event.Although requested, additional information has not been made available.The adverse event / malfunction is filed under aag reference (b)(4).
Additional Manufacturer Narrative
Manufacturing site evaluation investigation on-going.Should relevant additional information / investigation results become available, a supplemental medwatch report will be submitted.
Additional Manufacturer Narrative
Additional information: investigation results: as of the date of this report the complaint product was not provided for investigation.Therefore, a thorough investigation is not possible.Batch history review: the device quality and manufacturing history records have been checked for the available lot number and were found to be according to our specifications valid at the time of production.Review of the complaint history revealed that no similar complaints have been filed against products from this batch number.Conclusion and measures / preventive measures: based upon the investigation results a clear root cause conclusion cannot be drawn.There is no indication for a material-, manufacturing- or design-related failure.In the event that the complaint product will be provided for investigation in the future, an update of this report will be provided unsolicited.Based upon the investigations results a capa is not necessary.

• Brand Name: HI-LINE CRANIOTOME HDPC W/O DURAGUARD
• Common Device Name: POWER SYSTEMS
• Manufacturer (Section D): AESCULAP AG; po box 40; tuttlingen 78501
• Manufacturer (Section G): AESCULAP AG; po box 40; tuttlingen 78501
• Manufacturer Contact: christian von der grün ; po box 40; tuttlingen 78501
• MDR Report Key: 12939155
• Report Number: 9610612-2021-00746
• Device Sequence Number: 17303366
• Product Code: HWE
• UDI-Device Identifier: 04038653069996
• UDI-Public: 4038653069996
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K980686
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 01/20/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: GB520R
• Device Catalogue Number: GB520R
• Device Lot Number: 4509332148
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/08/2021
• Supplement Date Received by Manufacturer: 12/21/2021
• Initial Report FDA Received Date: 12/06/2021
• Supplement Report FDA Received Date: 01/20/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown