MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2017-09-17 for FIXTURE ST 4MM 90440 manufactured by Cochlear Bone Anchored Solutions Ab.
[86407723]
It was reported that the device was discarded and therefore unavailable for analysis by the manufacturer. This report is submitted on september 18, 2017, (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[86407724]
Per the clinic, the patient experienced a loss of osseointegration resulting in fixture loss. Subsequently, the patient was implanted with a new fixture on (b)(6) 2017.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 6000034-2017-01666 |
| MDR Report Key | 6871447 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2017-09-17 |
| Date of Report | 2017-08-27 |
| Date Mfgr Received | 2017-08-27 |
| Date Added to Maude | 2017-09-17 |
| 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 |
| Reporter Occupation | MEDICAL ASSISTANT |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MRS. BIANCA PRIES |
| Manufacturer Street | 1 UNIVERSITY AVENUE |
| Manufacturer City | MACQUARIE UNIVERSITY, NSW 2109 |
| Manufacturer Country | AS |
| Manufacturer Postal | 2109 |
| Manufacturer G1 | COCHLEAR BONE ANCHORED SOLUTIONS AB |
| Manufacturer Street | KONSTRUKTIONSV PO BOX 82 |
| Manufacturer City | M 43533 |
| Manufacturer Country | SW |
| Manufacturer Postal Code | 43533 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | FIXTURE ST 4MM |
| Generic Name | COCHLEAR BAHA VISTAFIX SYSTEM |
| Product Code | FZE |
| Date Received | 2017-09-17 |
| Model Number | 90440 |
| Catalog Number | 90440 |
| Lot Number | 2716303 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | COCHLEAR BONE ANCHORED SOLUTIONS AB |
| Manufacturer Address | KONSTRUKTIONSV?GEN 14 PO BOX 82 M?LNLYCKE, 435 22 SW 435 22 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2017-09-17 |