BEUDAMED
    FDA Adverse Event Injury Summary report: N

    NOVATION

    MDR report key: 8949420 · Received August 30, 2019

    Report

    Report Number
    1038671-2019-00439
    Event Type
    Injury
    Date Received
    August 30, 2019
    Date of Event
    August 1, 2019
    Report Date
    December 13, 2019
    Manufacturer
    EXACTECH, INC.
    Product Code
    JDI
    PMA / PMN Number
    K070479
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SP
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 0

    THE ENGINEERING EVALUATION NOTED IN THE EXPERIENCE REPORTED THAT THE UNDERLYING CAUSE OF THE PROSTHESIS WEAR REPORTED CANNOT BE DETERMINED BECAUSE THE DEVICES HAVE NOT BEEN REVISED AND, THEREFORE, HAVE NOT BEEN RETURNED FOR EVALUATION. "EXCESSIVE WEAR OF THE IMPLANT COMPONENTS SECONDARY TO IMPINGEMENT OF COMPONENTS OR DAMAGE OF ARTICULAR SURFACES" IS LISTED IN THE PRODUCT LABELING UNDER DEVICE SPECIFIC RISKS. CONCOMITANT DEVICE(S): (CN: 180-11-58, SN: (B)(4)) NV CROWN CUP CLSR HL W/HA 58 GROUP 3. (CN: 164-01-14, SN: (B)(4)) ELEMENT-STEM, COLLARLESS W/HA, STD OFFSET, SZ 14. (CN: 142-36-93, SN: (B)(4)) COCR FEM HEAD 36MM -3.5 OFFSET 12/14.

    Additional Manufacturer Narrative · 1

    PENDING EVALUATION. CONCOMITANT MEDICAL DEVICE(S): (CN: 180-11-58, SN: (B)(4)) NV CROWN CUP CLSR HL W/HA 58 GROUP 3; (CN: 164-01-14, SN: (B)(4)) ELEMENT-STEM, COLLARLESS W/HA, STD OFFSET, SZ 14; (CN: 142-36-93, SN: (B)(4)) COCR FEM HEAD 36MM -3.5 OFFSET 12/14.

    Description of Event or Problem · 1

    PREMATURE WEAR OF POLYETHYLENE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    742279 NOVATION NV GXL LNR, LIPPED, 36MM ID, GROUP 3 CUPS JDI EXACTECH, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Other