| Brand Name | LEVEL ONE |
| Common Device Name | TWIST DRILL |
| Manufacturer (Section D) |
| KLS-Martin L.P. |
| 11201 st. johns ind. pkwy s |
| jacksonville FL 32246 |
|
| 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
|
|
+1(904)641-7746
|
|
| MDR Report Key | 50241945 |
| Report Number | 1000525271-2026-00046 |
| Device Sequence Number | 10267849 |
| Product Code |
HTW
|
| UDI-Device Identifier | 00888118040954 |
| UDI-Public | (01)00888118040954 |
| Combination Product (Y/N) | N |
| Initial Reporter State | SC |
| Initial Reporter Country | US |
| PMA/510(K) Number | CLS 1 Exempt |
| 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 |
| Report Date (Section B) |
08/06/2026 |
| 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 | 33420024 |
| 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 | 08/06/2026 |
| Initial Report FDA Received Date | 08/13/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| 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 | 60 YR |
| Patient Sex | Female |
|
|