MAUDE Adverse Event Report: MEDCAD ACCUPLAN SYSTEM; SURGICAL GUIDE

Model Number	ZB-KT001-H
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Event or Problem Description
The resin hybrid guides broke during the procedure.As it is unclear which side (left or right) failed, both sides are being reported for completeness.

• Brand Name: ACCUPLAN SYSTEM
• Common Device Name: SURGICAL GUIDE
• Manufacturer (Section D): MEDCAD; 501 s 2nd ave; ste a-1000; dallas TX 75226
• Manufacturer (Section G): MEDCAD; 3401 technology dr.; unit 3; plano TX 75074
• Manufacturer Contact: vishvani patel ; 501 s 2nd ave; ste a-1000; dallas, TX 75226 ; 2144538864
• MDR Report Key: 23039316
• Report Number: 3009196021-2025-00014
• Device Sequence Number: 9477136
• Product Code: DZJ
• UDI-Device Identifier: 00810007631219
• UDI-Public: (01)00810007631219(10)251774CAP
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K223024
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 09/12/2025

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: ZB-KT001-H
• Device Catalogue Number: ZB-KT001-H
• Device Lot Number: 251774CAP
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/19/2025
• Initial Report FDA Received Date: 09/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 07/21/2025
• Is the Device Labeled for Single Use? (Y/N): Yes
• 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 Age: 25 YR
• Patient Sex: Male