FDA Adverse Event Injury Summary report: N

QUADRA-S CEMENTLESS, SAND BLASTED LAT STEM

MDR report key: 4963983 · Received July 29, 2015

Report

Report Number
3005180920-2015-00153
Event Type
Injury
Date Received
July 29, 2015
Report Date
October 30, 2015
Manufacturer
MEDACTA INTERNATIONAL, SA
Product Code
JDI
PMA / PMN Number
K072857
Report Source
Manufacturer report
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

ON 01 OCTOBER 2015 IT WAS PREPARED A FINAL REPORT WITH THE INFORMATION ALREADY SUBMITTED IN THE INITIAL REPORT. ON 02 OCTOBER 2015 THE REPORT WAS SENT TO THE INITIAL REPORTER AND THE CASE WAS CLOSED.

Additional Manufacturer Narrative · 1

BATCH REVIEW PERFORMED ON (B)(6), 2015. QUADRA-S STEM, (B)(4), LOT 100302: (B)(4) ITEMS PRODUCED AND RELEASED ON (B)(6), 2010. NO ANOMALIES FOUND. TO DATE, ALL ITEMS OF THE LOT HAVE BEEN SOLD WITHOUT ANY SIMILAR ISSUE. CANCELLOUS BONE SCREW, FLAT HEAD 6, 5 L 25 (B)(4), LOT 102339 (K103352); (B)(4) ITEMS PRODUCED AND RELEASED ON (B)(6), 2010. NO ANOMALIES FOUND. TO DATE, (B)(4) ITEMS OF THE LOT HAVE BEEN SOLD WITHOUT ANY SIMILAR ISSUE. CANCELLOUS BONE SCREW, FLAT HEAD 6, 5 L 30 (B)(4), LOT 081635 (K103352): (B)(4) ITEMS PRODUCED AND RELEASED ON (B)(6), 2008. NO ANOMALIES FOUND. TO DATE, (B)(4) ITEMS OF THE LOT HAVE BEEN SOLD WITHOUT ANY SIMILAR ISSUE. CERAMIC LINER AND HEAD WERE ALSO EXPLANTED, IMPLANT NOT MARKETED IN US. ON (B)(6), 2015, THE MFR OF THE CERAMIC IMPLANT WAS INFORMED ABOUT THE EVENT. ON JULY 24, 2015, THEY REPLIED THAT NO ANOMALY WAS FOUND IN THEIR PRODUCTION DOCUMENT. MOREOVER, ALSO THE CUP WAS EXPLANTED, IMPLANT NOT MARKET IN US. . NO ANOMALIES FOUND. ON JUNE 30, 2015, WE HAVE BEEN INFORMED THAT X-RAYS AND PIECES WON'T BE AVAILABLE FOR FURTHER INVESTIGATIONS.

Description of Event or Problem · 1

(B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
492530 QUADRA-S CEMENTLESS, SAND BLASTED LAT STEM CEMENTLESS FEMORAL STEM JDI MEDACTA INTERNATIONAL, SA

Patients

Seq Age Sex Outcome Treatment
1