HTR * PMI PURIFOY RIGHT FRONTAL SPHENOID PARIETAL TEMPORAL IMPLANT N/A PM616540

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,health profession report with the FDA on 2018-12-01 for HTR * PMI PURIFOY RIGHT FRONTAL SPHENOID PARIETAL TEMPORAL IMPLANT N/A PM616540 manufactured by Biomet Microfixation.

Event Text Entries

[129022892] Zimmer biomet complaint (b)(4). Date of event and explant date: it is reported the revision is scheduled for (b)(6) 2018, however this has not been confirmed at this time. Concomitant medical devices: biomet microfixation 1. 5 mm system 2 hole long straight plate, catalog #: 01-7347, lot #: 088620; biomet microfixation 1. 5 mm system high torque (ht), sd, x-dr, screw 1. 5 mm x 4 mm, catalog #: 91-6104, lot #: 672380. Therapy date: unknown. Customer has indicated that the product will not be returned to zimmer biomet for investigation, it remains implanted in the patient. The investigation is in process. Once the investigation has been completed, a follow-up mdr will be submitted. Multiple mdr reports were filed for this event, please see associated reports: 0001032347-2018-00823 and 0001032347-2018-00824.
Patient Sequence No: 1, Text Type: N, H10


[129022893] It was reported the patient was involved in an accident/ "wreck" that caused the cranioplasty implant to break. A revision is planned to remove and replace the existing implant. No additional patient consequences were reported.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number0001032347-2018-00822
MDR Report Key8122171
Report SourceDISTRIBUTOR,HEALTH PROFESSION
Date Received2018-12-01
Date of Report2018-11-30
Date Mfgr Received2018-11-02
Device Manufacturer Date2015-04-28
Date Added to Maude2018-12-01
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag0
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMRS. MICHELLE COLE
Manufacturer Street1520 TRADEPORT DRIVE
Manufacturer CityJACKSONVILLE FL 32218
Manufacturer CountryUS
Manufacturer Postal32218
Manufacturer Phone9047414400
Manufacturer G1BIOMET MICROFIXATION
Manufacturer Street1520 TRADEPORT DRIVE
Manufacturer CityJACKSONVILLE FL 32218
Manufacturer CountryUS
Manufacturer Postal Code32218
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameHTR * PMI PURIFOY RIGHT FRONTAL SPHENOID PARIETAL TEMPORAL IMPLANT
Generic NameHARD TISSUE REPLACEMENT (HTR) - PATIENT MATCHED IMPLANT
Product CodeKKY
Date Received2018-12-01
Model NumberN/A
Catalog NumberPM616540
Lot Number606120
Device Expiration Date2018-04-30
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBIOMET MICROFIXATION
Manufacturer Address1520 TRADEPORT DRIVE JACKSONVILLE FL 32218 US 32218


Patients

Patient NumberTreatmentOutcomeDate
101. Hospitalization; 2. Required No Informationntervention 2018-12-01

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