MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2005-08-26 for SMART STAPES PISTON 70145928 manufactured by Gyrus Ent.
[421548]
A patient required a revision surgery post-op a partial ossicular replacement procedure due to a loss of hearing. The implant was explanted and replaced. The surgeon states that the implant was found out of the oval window and off of the incus.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1037007-2005-00007 |
| MDR Report Key | 631021 |
| Report Source | 07 |
| Date Received | 2005-08-26 |
| Date of Report | 2005-08-26 |
| Date of Event | 2005-04-29 |
| Date Mfgr Received | 2005-08-10 |
| Date Added to Maude | 2005-08-30 |
| 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 | 3 |
| Manufacturer Contact | MR. DOLAN MILLS |
| Manufacturer Street | 2925 APPLING RD. |
| Manufacturer City | BARTLETT TN 38133 |
| Manufacturer Country | US |
| Manufacturer Postal | 38133 |
| Manufacturer Phone | * |
| Manufacturer G1 | GYRUS ENT |
| Manufacturer Street | 2925 APPLING RD. |
| Manufacturer City | BARTLETT TN 38133 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 38133 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SMART STAPES PISTON |
| Generic Name | PARTIAL OSSICULAR REPLACEMENT PROSTHESIS |
| Product Code | ETB |
| Date Received | 2005-08-26 |
| Returned To Mfg | 2005-09-07 |
| Model Number | NA |
| Catalog Number | 70145928 |
| Lot Number | UNK |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | 6 MO |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | Y |
| Date Removed | V |
| Device Sequence No | 1 |
| Device Event Key | 620615 |
| Manufacturer | GYRUS ENT |
| Manufacturer Address | * BARTLETT TN 38133 US |
| Baseline Brand Name | SMART |
| Baseline Generic Name | PISTON |
| Baseline Model No | NA |
| Baseline Catalog No | 70145928 |
| Baseline ID | NA |
| Baseline Device Family | SMART STAPES PISTON PROSTHESIS |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K003214 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization | 2005-08-26 |