FDA Adverse Event Injury Summary report: N

PCA IMPLANT

MDR report key: 4001 · Received July 8, 1992

Report

Report Number
4001
Event Type
Injury
Date Received
July 8, 1992
Date of Event
April 15, 1992
Report Date
April 28, 1992
Manufacturer
HOWMEDICA, INC.
Product Code
HRY
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

A RIGHT TOTAL KNEE REPLSCEMENT WAS PERFORMED IN 2/88. IN 3/92, THE PATIENT EXPERIENCED DECREASED RIGHT KNEE RANGE OF MOTION AND INSTABILITY UPON WALKING. X-RAY REVEALED WEARING OF (R) KNEE PROSTHESIS AND PATELLA COMPONENT WAS FOUND TO BE FRACTURED AND WAS REPLACED W/O COMPLICATION ON 4/15/92. ADDITIONAL ORIGINAL DEVICES INVOLVED (2 OTHER COMPONENTS OF (R) TOTAL KNEE REPLACEMENT UNIT) WERE: HOWMEDIA FEMORAL AND TIBIAL COMPONENTS; THESE COMPONENTS REMAIN INTACT AND STABLE. THE DEVICE PURCHASE DATE IS UNKNOWNDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, VISUAL EXAMINATION. RESULTS OF EVALUATION: NONE OR UNKNOWN. CONCLUSION: DEVICE FAILURE DIRECTLY CONTRIBUTED TO EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE RETURNED TO MANUFACTURER/DEALER/DISTRIBUTOR, OTHER. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PCA IMPLANT Implant TOTAL KNEE IMPLANT HRY HOWMEDICA, INC. N/A PDDHDA 8732299

Patients

Seq Age Sex Outcome Treatment
1 80 YR Required Intervention