MAUDE Adverse Event Report: MAKO SURGICAL CORP. BENT HOHMANN RETRACTOR; STEREOTAXIC DEVICE, ROBOTICS

Catalog Number	210191
Medical Device Problem Codes	Mechanical Problem (1384); Non Reproducible Results (4029)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	09/27/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
As part of normal complaint follow-up, an evaluation of the event has been initiated by mako surgical.A supplemental report will be submitted when additional information becomes available.
Event or Problem Description
Found damaged retractor in cpd- has gauges from saw blade.Case type: no associated procedure.
Additional Manufacturer Narrative
Reported event: customer reported a damaged retractor in cpd- has gauges from saw blade.Device evaluation and results: device evaluation was not performed and the bent hohmann retractor event was not confirmed.Device history review: review of the device history records indicate 95 devices were manufactured and accepted into final stock on (b)(6) 2018 with no reported discrepancies.Complaint history review: -based on the device identification, the catsweb and trackwise complaint databases were reviewed from 2011 to present for similar reported events regarding the bent hohmann retractor.There have been no others event for the referenced lot number.Conclusions: no product inspection could be completed due to the product not being returned.Per d03391, preventive maintenance identifies device deterioration which may compromise function.Under pm conditions no patient was involved and no actual or potential patient harm existed for the alleged event.No additional investigation or specific actions are required.Corrective action/preventive action: as the event did not involve a manufacturing related product problem indicating a non-conformity, adverse trend, or unanticipated hazard, no corrective action is required at this time.
Event or Problem Description
Found damaged retractor in cpd- has gauges from saw blade.Case type: no associated procedure.

• Brand Name: BENT HOHMANN RETRACTOR
• Common Device Name: STEREOTAXIC DEVICE, ROBOTICS
• Manufacturer (Section D): MAKO SURGICAL CORP.; 2555 davie road; fort lauderdale FL 33317
• MDR Report Key: 7925909
• Report Number: 3005985723-2018-00568
• Device Sequence Number: 19348855
• Product Code: OLO
• UDI-Device Identifier: 00848486031909
• UDI-Public: 00848486031909
• Combination Product (Y/N): N
• Initial Reporter State: MI
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 01/03/2019

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 Catalogue Number: 210191
• Device Lot Number: 41298
• Was Device Available for Evaluation?: Yes
• Initial Date Received by Manufacturer: 09/27/2018
• Supplement Date Received by Manufacturer: 12/31/2018
• Initial Report FDA Received Date: 10/02/2018
• Supplement Report FDA Received Date: 01/03/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Hospitalization