JOURNEY FEM IMPL IMPACTOR 74012831

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-03-31 for JOURNEY FEM IMPL IMPACTOR 74012831 manufactured by Smith & Nephew, Inc..

Event Text Entries

[185720714] It was reported that during a tka procedure the journey fem impl impactor broke inside of the patient. No pieces fell into the wound. All pieces were recovered. No surgical delay was reported but an s and n backup device was available.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1020279-2020-01101
MDR Report Key9903121
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2020-03-31
Date of Report2020-03-31
Date of Event2020-03-03
Date Mfgr Received2020-03-03
Date Added to Maude2020-03-31
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactDR. SARAH FREESTONE
Manufacturer Street1450 BROOKS ROAD
Manufacturer CityMEMPHIS TN 38116
Manufacturer CountryUS
Manufacturer Postal38116
Manufacturer Phone0447940038
Manufacturer G1SMITH & NEPHEW, INC.
Manufacturer Street1450 BROOKS ROAD
Manufacturer CityMEMPHIS TN 38116
Manufacturer CountryUS
Manufacturer Postal Code38116
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameJOURNEY FEM IMPL IMPACTOR
Generic NamePROSTHESIS, KNEE, FMOROTIBIAL, SEMI-CONSTRAINED, CEMENTED, METAL/POLYMR
Product CodeHRY
Date Received2020-03-31
Returned To Mfg2020-03-16
Model Number74012831
Catalog Number74012831
Lot Number19FK00008
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerSMITH & NEPHEW, INC.
Manufacturer Address1450 BROOKS ROAD MEMPHIS TN 38116 US 38116


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-31

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