MAUDE Adverse Event Report: WALDEMAR LINK GMBH & CO. KG PRESS, STAINLESS STEEL; SURGICAL PRESS

Model Number	184-360/00
Medical Device Problem Code	Mechanical Jam (2983)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/10/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The report is delayed due to original classification of the case as non-reportable.Due to the recent fda inspection we reevaluated the complaint in comparison to similar complaints with different outcomes and therefore determined that it is reportable.We have addressed this observation in capa-23-08.
Event or Problem Description
Thread cut together and stuck.

• Brand Name: PRESS, STAINLESS STEEL
• Common Device Name: SURGICAL PRESS
• Manufacturer (Section D): WALDEMAR LINK GMBH & CO. KG; barkhausenweh 10; hamburg, hamburg 22339 ; GM 22339
• Manufacturer Contact: annerike-tizia hucklenbroch ; barkhausenweg 10; hamburg, hamburg 22339 ; GM 22339
• MDR Report Key: 17641713
• Report Number: 3004371426-2023-00091
• Device Sequence Number: 18126779
• Product Code: LZO
• UDI-Device Identifier: 04026575185948
• UDI-Public: 04026575185948
• Combination Product (Y/N): N
• Initial Reporter Country: SW
• PMA/510(K) Number: K190535
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 05/25/2021

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: 184-360/00
• Device Catalogue Number: 184-360/00
• Device Lot Number: B809071
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/01/2021
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 05/25/2021
• Initial Report FDA Received Date: 08/29/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 03/01/2018
• 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: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown