FDA Adverse Event Injury Summary report: N

ATUNE CR RT MS INS SZ 7 6

MDR report key: 23896778 · Received December 26, 2025

Report

Report Number
1818910-2025-22578
Event Type
Injury
Date Received
December 26, 2025
Date of Event
December 9, 2025
Manufacturer
DEPUY IRELAND - 3015516266
Product Code
JWH
UDI-DI
10603295542650
PMA / PMN Number
K211609
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
WA, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

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. THE PRODUCT INVESTIGATION FOUND NO EVIDENCE SUSPECTING AN ERROR IN THE MANUFACTURING OR MATERIAL THAT WOULD BE A CONTRIBUTING FACTOR IN THE REPORTED ALLEGATION(S). A RECORDS EVALUATION (MRE) WAS NOT PERFORM. 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: THE PRODUCT INVESTIGATION FOUND NO EVIDENCE SUSPECTING AN ERROR IN THE MANUFACTURING OR MATERIAL THAT WOULD BE A CONTRIBUTING FACTOR IN THE REPORTED ALLEGATION(S). A MANUFACTURING RECORDS EVALUATION (MRE) WAS NOT PERFORMED. ADDED: B5. CORRECTED: H6 (CLINICAL CODE).

Description of Event or Problem · 0

IT WAS REPORTED THAT PATIENT WAS REVISED WITH LINER EXCHANGE DUE TO LAXITY IN THE KNEE. THICKER POLY WAS PUT IN. DOI: (B)(6) 2024. DOR: (B)(6) 2025. AFFECTED SIDE- RIGHT KNEE.

Description of Event or Problem · 0

ADDITIONAL INFORMATION RECEIVED: A. WHAT IS THE REASON FOR REVISION? WAS THE PATIENT EXPERIENCING ANY ADVERSE SYMPTOMS/CONSEQUENCE THAT LED TO THE REVISION SURGERY? -THE PATIENT HAD LAXITY IN THE KNEE, THEREFORE UPSIZE POLY. B .WAS THERE ANY ALLEGED DEFICIENCY TO THE EXPLANTED DEVICE? IF YES, PLEASE PROVIDE DETAILS. -NO. C . WHAT WAS THE EXACT ALLEGATION ? -LAXITY IN THE KNEE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
502751 ATUNE CR RT MS INS SZ 7 6 KNEE IMPLANT - TIBIAL INSERT JWH DEPUY IRELAND - 3015516266 M77M73 10603295542650

Patients

Seq Age Sex Outcome Treatment
1 61 YR Male Required Intervention