FDA Adverse Event Malfunction Summary report: N

ACCOLADE TMZF FEMORAL RASP SIZE 3

MDR report key: 3852176 · Received June 5, 2014

Report

Report Number
0002249697-2014-02131
Event Type
Malfunction
Date Received
June 5, 2014
Date of Event
May 15, 2014
Report Date
May 15, 2014
Manufacturer
STRYKER ORTHOPAEDICS-MAHWAH
Product Code
LXH
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IL, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

THE PATIENT IS (B)(6). AN EVENT REGARDING AN ACCOLADE TMZF STEM THAT SAT PROUD INVOLVING AN ACCOLADE TMZF RASP WAS REPORTED. THE EVENT WAS NOT CONFIRMED. MEDICAL RECORDS RECEIVED AND EVALUATION: THE PROVIDED MEDICAL INFORMATION WAS SUBMITTED TO A CONSULTING CLINICIAN WHO DEEMED IT INSUFFICIENT FOR A MEDICAL REVIEW. CONCLUSIONS: THE EVENT COULD NOT BE CONFIRMED NOR THE ROOT CAUSE DETERMINED BECAUSE THE DEVICES WERE NOT RETURNED FOR EVALUATION AND INSUFFICIENT MEDICAL INFORMATION WAS PROVIDED.

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION HAS BEEN REQUESTED AND IF RECEIVED, WILL BE PROVIDED IN THE SUPPLEMENTAL REPORT UPON COMPLETION OF THE INVESTIGATION. HOSPITAL RETAINED DEVICE.

Description of Event or Problem · 1

IT WAS REPORTED DURING INITIAL SURGERY OF RIGHT HIP THERE WAS AN ISSUE WITH ACCOLADE TMZF STEM. DOCTOR WENT TO BROACH #3 STEM. IMPLANT AND STEM SAT PROUD ABOUT 1CM. DOCTOR TOOK OUT NUMBER 3 AND INSERT 2 1/2 STEM, THIS LED TO A DELAY IN SURGERY.

Description of Event or Problem · 1

IT WAS REPORTED DURING INITIAL SURGERY OF RIGHT HIP THERE WAS AN ISSUE WITH ACCOLADE TMZF STEM. DOCTOR WENT TO BROACH #3 STEM. IMPLANT AND STEM SAT PROUD ABOUT 1CM. DOCTOR TOOK OUT NUMBER 3 AND INSERT 2 1/2 STEM, THIS LED TO A DELAY IN SURGERY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
329514 ACCOLADE TMZF FEMORAL RASP SIZE 3 INSTRUMENT LXH STRYKER ORTHOPAEDICS-MAHWAH UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 71 YR Other