MAUDE MDR 5093503

MDR report key
5093503
Report number
0001825034-2015-04051
Event key
0
Event type
3
Date of event
2015-09-08
Date received
2015-09-22
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 MONOBLOCK SHELL INSRTRPROSTHESIS, HIPBIOMET ORTHOPEDICSLKDN/A110003450280640R R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-09-2201. S

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 OR DEVIATION. THERE ARE WARNINGS IN THE PACKAGE INSERT THAT STATE THAT THIS TYPE OF EVENT CAN OCCUR: ?INTRAOPERATIVE FRACTURE OR BREAKING OF INSTRUMENTS HAS BEEN REPORTED FOR GENERAL INSTRUMENTS.? 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.

D

Patient 1

IT WAS REPORTED THAT A PATIENT UNDERWENT AN INITIAL LEFT TOTAL HIP ARTHROPLASTY ON (B)(6) 2015. DURING THE PROCEDURE, THE G7 INSERTER THREADS FRACTURED DURING IMPACTION OF INSERTING THE CUP. THE CUP WAS WELL FIXED SO THE SURGEON DECIDED TO LEAVE IT; THE THREADS REMAINED IN THE CUP. THERE WAS NO DELAY IN PROCEDURE. THE SURGEON USED A FACE PLATE IMPACTOR TO COMPLETE THE PROCEDURE.

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. EVALUATION OF RETURNED DEVICE FOUND THE ACETABULAR INSERTER?S THREADS HAD FRACTURED AS STATED IN THE COMPLAINT. PRODUCT LIKELY FAILED DUE TO MISUSE BY PRODUCT BEING PUT THROUGH BENDING OVERLOAD FORCE.