MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2010-07-20 for HA LITE ADJUSTABLE LENGTH OSSICULAR PARTIAL 685 manufactured by Grace Medical.
[16742966]
The physician reported that he had implanted the device approximately a year ago. The patient had been experiencing a decline in hearing. A revision surgery was performed. The physician reported that the head had separated from the silicone that holds it on the shaft.
Patient Sequence No: 1, Text Type: D, B5
[17058289]
Multiple attempts were made to gather information from the physician. No additional information is expected.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1057421-2010-00002 |
| MDR Report Key | 1768337 |
| Report Source | 05 |
| Date Received | 2010-07-20 |
| Date of Report | 2010-07-16 |
| Date of Event | 2010-06-18 |
| Date Mfgr Received | 2010-06-18 |
| Date Added to Maude | 2010-07-28 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | BILL GRAHAM, MANAGER |
| Manufacturer Street | 8500 WOLF LAKE DRIVE SUITE 110 |
| Manufacturer City | MEMPHIS TN 38133 |
| Manufacturer Country | US |
| Manufacturer Postal | 38133 |
| Manufacturer Phone | 9013860990 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HA LITE ADJUSTABLE LENGTH OSSICULAR PARTIAL |
| Generic Name | PARTIAL OSSICULAR REPLACEMENT PROSTHESIS |
| Product Code | ETB |
| Date Received | 2010-07-20 |
| Catalog Number | 685 |
| Lot Number | UNKNOWN |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | GRACE MEDICAL |
| Manufacturer Address | MEMPHIS TN US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2010-07-20 |