Brand Name | DISPOSABLE WITH SPATULA MIXING BOWL |
Type of Device | BONE CEMENT MIXER |
Manufacturer (Section D) |
ZIMMER BIOMET, INC. |
56 e. bell drive |
warsaw IN 46582 |
|
Manufacturer (Section G) |
ZIMMER BIOMET, INC. |
56 e. bell drive |
|
warsaw IN 46582 |
|
Manufacturer Contact |
christina
arnt
|
56 e. bell dr. |
warsaw, IN 46582
|
5745273773
|
|
MDR Report Key | 14087871 |
MDR Text Key | 289539886 |
Report Number | 0001822565-2022-01028 |
Device Sequence Number | 1 |
Product Code |
JDZ
|
UDI-Device Identifier | 00889024376564 |
UDI-Public | (01)00889024376564(17)250131(10)64633897 |
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | EXEMPT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,Company Representative |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial,Followup |
Report Date |
06/02/2022 |
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
|
Device Operator |
Health Professional
|
Device Model Number | N/A |
Device Catalogue Number | 00504901100 |
Device Lot Number | 64633897 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
03/21/2022 |
Initial Date FDA Received | 04/12/2022 |
Supplement Dates Manufacturer Received | 06/01/2022
|
Supplement Dates FDA Received | 06/02/2022
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 01/22/2020 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Removal/Correction Number | NI |
Patient Sequence Number | 1 |