FDA Adverse Event Injury Summary report: N

LOGIC

MDR report key: 15414337 · Received September 13, 2022

Report

Report Number
1038671-2022-01103
Event Type
Injury
Date Received
September 13, 2022
Date of Event
August 8, 2022
Report Date
October 22, 2025
Manufacturer
EXACTECH, INC.
Product Code
JWH
UDI-DI
10885862001856
PMA / PMN Number
K093360
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

NO DEVICE RETURN ANTICIPATED DUE TO CLINICAL STUDY POLICY. CONCOMITANTS: 02-010-01-0235 LOGIC FEMORAL PS CEM LEFT SZ 3.5, 02-012-45-3535 LGC TIBIAL FIT TRAY CEM SZ 3.5F / 3.5T, 200-02-38 THREE PEG PATELLA 38MM, FEMORAL STEM. ADDITIONAL INFORMATION, INCLUDING THE PRODUCT INVESTIGATION, WILL BE SUBMITTED WITHIN 30 DAYS OF RECEIPT.

Additional Manufacturer Narrative · 0

BASED ON REVIEW OF ALL AVAILABLE INFORMATION, THERE IS NO EVIDENCE TO SUGGEST THAT THE REPORTED EVENT IS RELATED TO ANY DESIGN OR MANUFACTURING ISSUES. THE CAUSE OF THE SUBSEQUENT REVISION CANNOT BE CONCLUSIVELY DETERMINED; REASON WAS NOT REPORTED; HOWEVER, IT IS MOST LIKELY RELATED TO THE PATIENT'S UNDERLYING MULTIPLE JOINT CONDITIONS.

Description of Event or Problem · 0

IT WAS REPORTED VIA A CLINICAL STUDY, EXACTECH KNEE REPLACEMENT STUDY, THAT A 71 YO MALE, H: 172 CM, WHO WAS INITIALLY IMPLANTED ON THE LEFT KNEE ON (B)(6) 2016 FOR THE PRIMARY INDICATION OF OSTEOARTHRITIS, UNDERWENT A SINGLE STAGE REVISION ON (B)(6) 2022 APPROXIMATELY 6 YEARS 1 MONTH POST THE INITIAL IMPLANT PROCEDURE. STUDY INDICATES THE OUTCOME AS RESOLVED ON (B)(6) 2022.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2391886 LOGIC PROSTHESIS, KNEE, PATELLOFEMOROTIBIAL, SEMI-CONSTRAINED, CEMENTED, JWH EXACTECH, INC. LOGIC TIBIA PS MOD INSRT SZ 3.5 11MM UNK 10885862001856

Patients

Seq Age Sex Outcome Treatment
1 NA Male Required Intervention SEE H10.