MAUDE MDR 5070240

MDR report key
5070240
Report number
0001825034-2015-03949
Event key
0
Event type
3
Date of event
2015-08-19
Date received
2015-09-11
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MS. MEGAN HAAS
Address
56 E. BELL DRIVE WARSAW IN 46582 US
Phone
574-574-5743
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1G7 STR INSERTER THREADED SHAFTPROSTHESIS, HIPBIOMET ORTHOPEDICSLKDN/A110003452373941Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-09-1101. R

Event Narratives#

N

Patient 1

CURRENT INFORMATION IS INSUFFICIENT TO PERMIT A CONCLUSION AS TO THE CAUSE OF THE EVENT. REVIEW OF DEVICE HISTORY RECORDS SHOW THAT LOT RELEASED WITH NO RECORDED ANOMALY. DEVICE AVAILABILITY - THE DEVICE IS REPORTED TO BE AVAILABLE FOR EVALUATION; HOWEVER, IT HAS NOT BEEN RECEIVED BY BIOMET ORTHOPEDICS TO DATE. IN THE EVENT THAT THE DEVICE IS RECEIVED AND EVALUATED, A FOLLOW UP REPORT WILL BE SENT TO THE FDA TO PROVIDE RESULTS. THIS REPORT IS NUMBER 2 OF 2 MDR'S FILED FOR THE SAME EVENT (REFERENCE 1825034-2015-03948 / 03949).

D

Patient 1

IT WAS REPORTED THAT A PATIENT UNDERWENT AN INITIAL HIP ARTHROPLASTY ON (B)(6) 2015. DURING THE PROCEDURE, THE CUP INSERTER BECAME MARRED UPON IMPACTION AND THE INNER LOCK BOLT BECAME CAPTURED INSIDE THE HANDLE. THE ENTRY HOLE WAS ALSO DISFIGURED AND THE INNER BOLT COULD NOT PASS FREELY. THE DISTAL THREAD ALSO BECAME DEFORMED DUE TO IMPACTION. THE INNER POLY WAS SEATED BY IMPACTION. THE INSERTER WAS USED TO COMPLETE THE PROCEDURE. NO FURTHER INFORMATION HAS BEEN PROVIDED.

N

Patient 1

THIS FOLLOW-UP REPORT IS BEING FILED TO RELAY ADDITIONAL INFORMATION, WHICH WAS UNKNOWN AT THE TIME OF THE INITIAL MEDWATCH.

N

Patient 1

EXAMINATION OF RETURNED DEVICE FOUND NO EVIDENCE OF PRODUCT NON-CONFORMANCE. BASED ON DEVICE HISTORY RECORDS, THE PRODUCT WAS MADE TO PRINT AND CORRECT MATERIALS. HE THREADED INSERTER SHAFT CANNOT BE INSERTED INTO THE THROUGH HOLE OF THE HANDLE BODY DUE TO THE DAMAGE. INSTRUMENT LIKELY FAILED DUE TO EXCESSIVE IMPACTS TO THE STRIKE PLATE, WHICH DEFORMED MATERIAL AROUND THROUGH HOLE.