BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SMARTSET MV 40G - EO

    MDR report key: 19404182 · Received May 28, 2024

    Report

    Report Number
    1818910-2024-11580
    Event Type
    Malfunction
    Date Received
    May 28, 2024
    Date of Event
    May 13, 2024
    Report Date
    May 28, 2024
    Manufacturer
    DEPUY IRELAND - 3015516266
    Product Code
    LOD
    UDI-DI
    10603295168379
    PMA / PMN Number
    K081155
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    PRODUCT COMPLAINT # (B)(4). THIS REPORT IS BEING SUBMITTED PURSUANT TO THE PROVISIONS OF 21 CFR, PART 803 (AND/OR PART 4, AS APPLICABLE). THIS REPORT MAY BE BASED ON INFORMATION WHICH HAS NOT BEEN INVESTIGATED OR VERIFIED PRIOR TO THE REQUIRED REPORTING DATE. THIS REPORT DOES NOT REFLECT A CONCLUSION BY DEPUY SYNTHES, OR ITS EMPLOYEES THAT THE REPORT CONSTITUTES AN ADMISSION THAT THE PRODUCT, DEPUY SYNTHES, OR ITS EMPLOYEES CAUSED OR CONTRIBUTED TO THE POTENTIAL EVENT DESCRIBED IN THIS REPORT. IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL REPORT, A FOLLOW-UP REPORT WILL BE FILED AS APPROPRIATE.

    Additional Manufacturer Narrative · 0

    PRODUCT COMPLAINT # (B)(4). INVESTIGATION SUMMARY :NO DEVICE ASSOCIATED WITH THIS REPORT WAS RECEIVED FOR EXAMINATION. PRODUCT DESCRIPTION:- SMARTSET MV 40G - EO PRODUCT CODE:- 3122040 LOT NO:- 4282471 MANUFACTURING DATE: 2023-10-02 EXPIRY DATE: 2025-09-30 QUANTITY: (B)(4). AS PART OF OUR COMPANY QUALITY SYSTEM PROCESS, ALL DEVICES ARE MANUFACTURED, INSPECTED, AND DISTRIBUTED TO APPROVED SPECIFICATIONS. ADDITIONAL COMPLAINT INFORMATION MONITORING FOR POTENTIAL SAFETY SIGNALS WILL BE CONDUCTED THROUGH COMPLAINT TRENDING AS PART OF THE POST-MARKET SURVEILLANCE. IF ADDITIONAL INFORMATION IS MADE AVAILABLE, THE INVESTIGATION WILL BE UPDATED AS APPLICABLE. DEVICE HISTORY LOT : PRODUCT DESCRIPTION:- SMARTSET MV 40G - EO PRODUCT CODE:- 3122040 LOT NO:- 4282471 MANUFACTURING DATE: 2023-10-02 EXPIRY DATE: 2025-09-30 QUANTITY: (B)(4). DEVICE HISTORY REVIEW ==> A MANUFACTURING RECORD EVALUATION WAS PERFORMED FOR THE FINISHED DEVICE, AND NO NON-CONFORMANCES / MANUFACTURING IRREGULARITIES WERE IDENTIFIED. H10 ADDITIONAL NARRATIVE: ADDED: A1, A2 (AGE, DOB), A3A

    Description of Event or Problem · 0

    IT WAS REPORTED THAT DEPUY CEMENT DID NOT HAVE STICKERS IN THE BOX.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    657464 SMARTSET MV 40G - EO BONE CEMENT : BONE CEMENT LOD DEPUY IRELAND - 3015516266 4282471 10603295168379

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Male