MAUDE Adverse Event Report: AESCULAP AG KERRISON 15MM NOIR 130DEG UP 200MM 3MM; BONE PUNCHES, RONGEURS

Model Number	FK982B
Medical Device Problem Code	Physical Resistance/Sticking (4012)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/24/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Manufacturing site evaluation: investigation on-going.Should relevant additional information / investigation results become available, a supplemental medwatch report will be submitted.
Event or Problem Description
It was reported to aesculap inc.That a kerrison 15mm noir 130deg up 200mm 3mm (material # fk982b) was used during a procedure performed on (b)(6) 2023.According to the complainant, the device became stuck after taking a bone bite.Reportedly, the physician encountered physical resistance while attempting to actuate the handle, which required him to use two (2) hands to forcibly release and retrieve the bone specimen.Prior to taking the bite, the handle functioned properly with smooth actuation noted.However, after taking the bone bite, the device jammed.Additional medical intervention was necessary to retrieve the dislodged bone fragment.The complaint device has been returned to the manufacturer for evaluation.The complaint device has not been returned to the manufacturer for evaluation.No patient complications were reported as a result of this event.The adverse event is filed under aic reference (b)(4).
Additional Manufacturer Narrative
Investigation results: the device was not returned to the manufacturer for physical evaluation.Additionally, no on-site evaluation of the unit was performed and no parts were returned for failure analysis.Therefore, the investigation was not able to confirm a device issue that could be associated with the reported event.Batch history review: the device history records (dhr) were not able to be reviewed as no lot number was made available.However, all device history records (dhr) are reviewed and released according to documented procedures and a device is not released if it does not meet requirements or is nonconforming.Conclusion and measures / preventative measures: a definitive conclusion regarding the complaint incident cannot be reached without a physical examination of the complaint device.
Event or Problem Description
Investigation complete.

• Brand Name: KERRISON 15MM NOIR 130DEG UP 200MM 3MM
• Common Device Name: BONE PUNCHES, RONGEURS
• Manufacturer (Section D): AESCULAP AG; po box 40; tuttlingen, 78501 ; GM 78501
• MDR Report Key: 17120064
• Report Number: 2916714-2023-00079
• Device Sequence Number: 12410512
• Product Code: LRY
• UDI-Device Identifier: 04038653476213
• UDI-Public: 4038653476213
• Combination Product (Y/N): N
• Initial Reporter State: IN
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Importer
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 08/02/2023
• Report Date (Section F): 06/13/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: FK982B
• Device Catalogue Number: FK982B
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 05/24/2023
• Event Location: Hospital
• Date Report to Manufacturer: 05/24/2023
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 06/13/2023
• Supplement Report FDA Received Date: 08/02/2023
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown
• Date Report Sent to FDA: 06/13/2023