MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2004-01-07 for FEM COMP ROT/HINGED KNEE RIGHT 6475-3-932 manufactured by Stryker Howmedica Osteonics.
[17766902]
It was reported "pt fell and experienced pain. X-rays showed a broken stem in the femoral component. The distal femoral component was resected and replaced with a new distal femur. "
Patient Sequence No: 1, Text Type: D, B5
Report Number | 2249697-2004-00002 |
MDR Report Key | 521842 |
Report Source | 07 |
Date Received | 2004-01-07 |
Date of Report | 2003-12-11 |
Date Mfgr Received | 2003-12-11 |
Date Added to Maude | 2004-04-26 |
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 | 3 |
Event Location | 0 |
Manufacturer Contact | JANICE PEVIDE |
Manufacturer Street | 300 COMMERCE COURT |
Manufacturer City | MAHWAH NJ 07430 |
Manufacturer Country | US |
Manufacturer Postal | 07430 |
Manufacturer Phone | 2018315000 |
Manufacturer G1 | * |
Manufacturer Street | * |
Manufacturer City | MAHWAH |
Manufacturer Country | * |
Single Use | 3 |
Remedial Action | OT |
Previous Use Code | 3 |
Removal Correction Number | NA |
Event Type | 3 |
Type of Report | 3 |
Brand Name | FEM COMP ROT/HINGED KNEE RIGHT |
Generic Name | IMPLANT |
Product Code | LGE |
Date Received | 2004-01-07 |
Model Number | NA |
Catalog Number | 6475-3-932 |
Lot Number | SDYVA |
ID Number | NA |
Operator | LAY USER/PATIENT |
Device Availability | Y |
Device Eval'ed by Mfgr | R |
Implant Flag | Y |
Date Removed | V |
Device Sequence No | 1 |
Device Event Key | 510969 |
Manufacturer | STRYKER HOWMEDICA OSTEONICS |
Manufacturer Address | 300 COMMERCE CT MAHWAH NJ 07430 US |
Baseline Brand Name | KINEMATIC KNEE FEMORAL COMPONENT |
Baseline Generic Name | ARTIFICIAL KNEE COMPONENT |
Baseline Model No | NA |
Baseline Catalog No | 6475-3-932 |
Baseline ID | NA |
Baseline Device Family | KINEMATIC |
Baseline Shelf Life Contained | Y |
Baseline Shelf Life [Months] | 60 |
Baseline PMA Flag | N |
Baseline 510K PMN | Y |
Premarket Notification | K792089 |
Baseline Preamendment | N |
Baseline Transitional | N |
510k Exempt | N |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 1. Required No Informationntervention | 2004-01-07 |