MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2018-04-16 for PROFORM HIP SYSTEM SC2677-35 manufactured by Stelkast Inc..
[105534555]
An evaluation of the device cannot be performed as the device was not returned. There is no evidence that a device malfunction was the cause of this incident.
Patient Sequence No: 1, Text Type: N, H10
[105534556]
Patient presented for right hip surgery. During surgery, the surgeon had difficulty seating the acetabular liner into the acetabular shell. The surgeon removed the shell, re-reamed and implanted the same shell with another screw. The same liner then was seated successfully.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2530191-2018-00041 |
| MDR Report Key | 7432528 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2018-04-16 |
| Date of Report | 2018-01-16 |
| Date of Event | 2018-04-06 |
| Date Mfgr Received | 2018-04-09 |
| Device Manufacturer Date | 2017-05-15 |
| Date Added to Maude | 2018-04-16 |
| 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 EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. JOHN REYHER |
| Manufacturer Street | 200 HIDDEN VALLEY ROAD |
| Manufacturer City | MCMURRAY PA 15317 |
| Manufacturer Country | US |
| Manufacturer Postal | 15317 |
| Manufacturer Phone | 7249416368 |
| Manufacturer G1 | STELKAST INC. |
| Manufacturer Street | 200 HIDDEN VALLEY ROAD |
| Manufacturer City | MCMURRAY PA 15317 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 15317 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PROFORM HIP SYSTEM |
| Generic Name | 6.5MM CANCELLOUS BONE |
| Product Code | JDO |
| Date Received | 2018-04-16 |
| Model Number | SC2677-35 |
| Lot Number | 39603270515 |
| Operator | MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | STELKAST INC. |
| Manufacturer Address | 200 HIDDEN VALLEY ROAD MCMURRAY PA 15317 US 15317 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization | 2018-04-16 |