FDA Adverse Event Injury Summary report: N

GMK PRIMARY TOTAL KNEE SYSTEM

MDR report key: 21771570 · Received April 4, 2025

Report

Report Number
3005180920-2025-00293
Event Type
Injury
Date Received
April 4, 2025
Date of Event
March 12, 2025
Report Date
April 4, 2025
Manufacturer
MEDACTA INTERNATIONAL SA
Product Code
JWH
UDI-DI
07630030819957
PMA / PMN Number
K090988
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
MO, US
Reporter Occupation
003

Narratives

Additional Manufacturer Narrative · 0

BATCH REVIEW PERFORMED ON 26 MARCH 2025: LOT 2100321: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 27-MAY-2021. EXPIRATION DATE: 2026-05-10. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENTS DURING THE PERIOD OF REVIEW. ADDITIONAL IMPLANTS INVOLVED; BATCH REVIEW PERFORMED ON 26 MARCH 2025: GMK-SPHERE 02.12.0007R FEMORAL COMPONENT SPHERE CEMENTED SIZE 7 R (K121416) LOT 2109971: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 13-OCT-2021. EXPIRATION DATE: 2026-10-01. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENTS DURING THE PERIOD OF REVIEW. GMK-SPHERE 02.12. E004RP PATELLA RESURFACING SIZE 4 E-CROSS (K202022) LOT 2012668: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 13-JAN-2021. EXPIRATION DATE: 2025-12-28. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENTS DURING THE PERIOD OF REVIEW. GMK-SPHERE 02.12. E0610FR TIBIAL INSERT FIXED SPHERE FLEX SIZE 6/10 MM R E-CROSS (K202022) LOT 2103978: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 26-MAY-2021. EXPIRATION DATE: 2026-05-02. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENTS DURING THE PERIOD OF REVIEW. INFECTION IS A KNOWN POSSIBLE COMPLICATION OF ANY SURGERY. ALTHOUGH NO ROOT CAUSE CAN BE ESTABLISHED, THERE IS NO INDICATION THAT ANY ISSUE WITH THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT, AND THE DOCUMENT REVIEW DOES NOT INDICATE ANY POTENTIAL MANUFACTURING RELATED CAUSE.

Description of Event or Problem · 0

AT ABOUT 2 YEARS 9 MONTHS AFTER THE PRIMARY, THE PATIENT CAME IN DUE TO SIGNS OF INFECTION AND THE PATHOGEN IS UNKNOWN. THE SURGEON REVISED ALL MEDACTA HARDWARE AND REIMPLANTED PERMANENT PRODUCT. THE SURGERY WAS COMPLETED SUCCESSFULLY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2333346 GMK PRIMARY TOTAL KNEE SYSTEM FIXED TIBIAL TRAY CEMENTED RIGHT, SIZE 6 JWH MEDACTA INTERNATIONAL SA 02.07.1206R 2100321 07630030819957

Patients

Seq Age Sex Outcome Treatment
1 77 YR Male Required Intervention