MAUDE MDR 9697069

MDR report key
9697069
Report number
1020279-2020-00514
Event key
0
Event type
3
Date of event
2020-01-29
Date received
2020-02-11
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
DR. SARAH FREESTONE
Address
1450 BROOKS ROAD MEMPHIS TN 38116 US
Phone
44-44-0447
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1GII PS HI FLEX ISRT TR S1-2 9TRAY, SURGICAL, INSTRUMENTSMITH & NEPHEW, INC.FSM7143040171430401R *

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-02-110

Event Narratives#

D

Patient 1

IT WAS REPORTED THAT DURING A TKA PROCEDURE, THE TRIAL INSERT CRACKED IN HALF WHILE INSERTING. NO INJURIES OR DELAYS REPORTED. A BACKUP DEVICE WAS AVAILABLE.