BEUDAMED
    FDA Adverse Event Injury Summary report: N

    GMK-SPHERE 02.12.E0511FL TIBIAL INSERT FIXED SPHERE FLEX SIZE 5/11 MM L E-CROSS

    MDR report key: 18020066 · Received October 27, 2023

    Report

    Report Number
    3005180920-2023-00822
    Event Type
    Injury
    Date Received
    October 27, 2023
    Date of Event
    September 22, 2023
    Report Date
    October 27, 2023
    Manufacturer
    MEDACTA INTERNATIONAL SA
    Product Code
    JWH
    UDI-DI
    07630971262034
    PMA / PMN Number
    K202022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    BATCH REVIEW PERFORMED ON 03 OCTOBER 2023. LOT 2243417: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 24-JAN-2023. EXPIRATION DATE: 2028-01-01. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW.

    Description of Event or Problem · 0

    AT ABOUT 2 MONTHS FROM THE PRIMARY, THE PATIENT CAME IN DUE TO SIGNS OF AN INFECTION AND THE PATHOGEN IS UNKNOWN. THE SURGEON PERFORMED A WASHOUT AND REVISED THE LINER. THE SURGERY WAS COMPLETED SUCCESSFULLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1675174 GMK-SPHERE 02.12.E0511FL TIBIAL INSERT FIXED SPHERE FLEX SIZE 5/11 MM L E-CROSS KNEE TIBIAL INSERT JWH MEDACTA INTERNATIONAL SA 2243417 07630971262034

    Patients

    Seq Age Sex Outcome Treatment
    1 Male Required Intervention