MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2020-01-21 for EQUINOXE UNK 320-42-13 manufactured by Exactech, Inc..
[176371471]
Pending evaluation concomitant device(s): equinoxe reverse tray adapter plate tray +0 (cat# 320-10-00 / sn# (b)(4)).
Patient Sequence No: 1, Text Type: N, H10
[176371472]
As reported, on a (b)(6) 2020 a (b)(6) male patient experienced a revision due to the humeral liner disassociated from the humeral tray which resulted in a dislocation. Patient was last known to be in stable condition following the event. The initial implant date is unknown. Devices will be returned to the manufacturer. Equinoxe reverse tray adapter plate tray +0 (cat# 320-10-00 / sn# (b)(4)).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1038671-2020-00011 |
| MDR Report Key | 9611032 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2020-01-21 |
| Date of Report | 2020-01-21 |
| Date of Event | 2020-01-06 |
| Date Mfgr Received | 2020-01-06 |
| Date Added to Maude | 2020-01-21 |
| 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 | KATE JACOBSON |
| Manufacturer Phone | 3523771140 |
| Manufacturer G1 | EXACTECH, INC. |
| Manufacturer Street | 2320 NW 66 CT |
| Manufacturer City | GAINESVILLE FL 32653 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 32653 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | EQUINOXE |
| Generic Name | REVERSE 42MM HUMERAL CONST LINER +2.5 |
| Product Code | KWT |
| Date Received | 2020-01-21 |
| Model Number | UNK |
| Catalog Number | 320-42-13 |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | EXACTECH, INC. |
| Manufacturer Address | 2320 NW 66 COURT GAINESVILLE FL 32653 US 32653 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2020-01-21 |