STRAIGHT MBLOC ACETABULAR SHELL INSERTER N/A 110003450

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2015-10-21 for STRAIGHT MBLOC ACETABULAR SHELL INSERTER N/A 110003450 manufactured by Biomet Orthopedics.

Event Text Entries

[28903847] 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. 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. There are warnings in the package insert that state that this type of event can occur: under care and handling of instruments, it states,? Surgical instruments and instrument cases are susceptible to damage for a variety of reasons including prolonged use, misuse, rough or improper handling. Care must be taken to avoid compromising their exacting performance.?
Patient Sequence No: 1, Text Type: N, H10


[28903848] It was reported that patient underwent a total hip arthroplasty on (b)(6), 2015. During the procedure, the inserter would not disengage from the acetabular cup after impaction. As a result, the cup was removed and another inserter and cup were utilized to complete the procedure. A delay greater than 30 minutes occurred as a result.
Patient Sequence No: 1, Text Type: D, B5


[35318936] This follow-up report is being filed to relay additional information, which was unknown at the time of the initial medwatch.
Patient Sequence No: 1, Text Type: N, H10


[36807529] Examination of returned device found no evidence of product non-conformance. Review of the device confirmed the reported condition. Root cause of the event was most likely attributed to damage to the threads of either the inserter or the cup; however, a conclusive root cause could not be determined.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number0001825034-2015-04399
MDR Report Key5166962
Date Received2015-10-21
Date of Report2016-01-20
Date of Event2015-09-30
Date Mfgr Received2016-01-20
Device Manufacturer Date2014-01-14
Date Added to Maude2015-10-21
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. MEGAN HAAS
Manufacturer Street56 E. BELL DRIVE
Manufacturer CityWARSAW IN 46582
Manufacturer CountryUS
Manufacturer Postal46582
Manufacturer Phone5743726700
Manufacturer G1BIOMET ORTHOPEDICS
Manufacturer Street56 E. BELL DRIVE
Manufacturer CityWARSAW IN 46582
Manufacturer CountryUS
Manufacturer Postal Code46582
Single Use3
Previous Use Code3
Removal Correction NumberN/A
Event Type3
Type of Report3

Device Details

Brand NameSTRAIGHT MBLOC ACETABULAR SHELL INSERTER
Generic NamePROSTHESIS, HIP
Product CodeLKD
Date Received2015-10-21
Returned To Mfg2015-12-18
Model NumberN/A
Catalog Number110003450
Lot Number856210
ID NumberN/A
OperatorPHYSICIAN
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBIOMET ORTHOPEDICS
Manufacturer Address56 E. BELL DRIVE WARSAW IN 46582 US 46582


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2015-10-21

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