| Brand Name | DISPOSABLE MIXING BOWL AND SPATULA |
| Common Device Name | MIXER, CEMENT, FOR CLINICAL USE |
| Manufacturer (Section D) |
| ZIMMER BIOMET, INC. |
| 1800 w. center st. |
| warsaw IN 46580 |
|
| Manufacturer (Section G) |
| ZIMMER BIOMET, INC. |
| 1800 w. center st. |
|
| warsaw IN 46580 |
|
| Manufacturer Contact |
|
jennifer
rapsavage
|
| 56 e. bell dr. |
| warsaw, IN 46582
|
|
5745260384
|
|
| MDR Report Key | 25151403 |
| Report Number | 0001822565-2026-01547 |
| Device Sequence Number | 10745699 |
| Product Code |
JDZ
|
| UDI-Device Identifier | 00889024376564 |
| UDI-Public | (01)00889024376564(17)301103(10)85682882 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | JA |
| PMA/510(K) Number | EXEMPT |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Company Representative |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
05/11/2026 |
| 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 |
Other
|
| Device Catalogue Number | 00504901100 |
| Device Lot Number | 85682882 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 03/31/2026 |
| Was the Report Sent to FDA? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 04/16/2026 |
| Initial Report FDA Received Date | 05/12/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 11/03/2025 |
| 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 Sex | Unknown |