| Brand Name | LEVEL ONE |
| Common Device Name | TWIST DRILL |
| Manufacturer (Section D) |
| KLS MARTIN SE & CO. KG |
| kolbinger strasse 10 |
| muehlheim/donau, 78570 |
| GM 78570 |
|
| Manufacturer (Section G) |
| KLS MARTIN SE & CO. KG |
| kolbinger strasse 10 |
|
| muehlheim/donau, 78570 |
|
GM
78570
|
|
| Manufacturer Contact |
|
melissa
bachorski
|
| p.o. box 16369 |
| jacksonville, FL 32245
|
|
9046417746
|
|
| MDR Report Key | 24306763 |
| Report Number | 9610905-2026-00007 |
| Device Sequence Number | 21200036 |
| Product Code |
HTW
|
| UDI-Device Identifier | 00888118040954 |
| UDI-Public | (01)00888118040954 |
| Combination Product (Y/N) | N |
| Initial Reporter State | GA |
| Initial Reporter Country | US |
| PMA/510(K) Number | CLS 1 EXEMPT |
| Exemption Number | 2017029 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2026 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
02/26/2026 |
| 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? |
No
|
| Operator of Device |
Health Professional
|
| Device Model Number | 25-452-00-91 |
| Device Lot Number | 33704557 |
| 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 | 01/21/2026 |
| Supplement Date Received by Manufacturer | 02/26/2026
|
| Initial Report FDA Received Date | 02/10/2026 |
| Supplement Report FDA Received Date | 03/23/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 11/05/2025 |
| 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 |
| Outcome Attributed to Adverse Event |
Other;
|
| Patient Age | 25 YR |
| Patient Sex | Male |
|
|