MAUDE Adverse Event Report: COCHLEAR LIMITED NUCLEUS CI522 COCHLEAR IMPLANT WITH SLIM STRAIGHT ELECTRODE; NUCLEUS 24 COCHLEAR IMPLANT SYSTEM

Model Number CI522

Device Problem No Device Output (1435)

Patient Problems Fall (1848); Head Injury (1879); Failure of Implant (1924)

Event Date 11/05/2021

Event Type  malfunction  

Manufacturer Narrative

This report is submitted on november 24, 2021.

Event Description

Per the clinic, the patient experienced a loss of connection to the internal device subsequent to falling and sustaining a head trauma.The implanted device remains.It is unknown if there are plans to explant the device and reimplant the patient with another cochlear device as of the date of this report.

Manufacturer Narrative

Per the clinic, the device was explanted on (b)(6) 2022 and the patient was re-implanted with a new cochlear device during the same surgery.This report is submitted on february 03, 2022.

Manufacturer Narrative

Device analysis indicated device failure.Device analysis report attached.This report is submitted on april 28, 2022.

• Brand Name: NUCLEUS CI522 COCHLEAR IMPLANT WITH SLIM STRAIGHT ELECTRODE
• Type of Device: NUCLEUS 24 COCHLEAR IMPLANT SYSTEM
• Manufacturer (Section D): COCHLEAR LIMITED; 1 university avenue; macquarie university; nsw 2109 ; AS 2109
• Manufacturer (Section G): COCHLEAR LTD; 1 university avenue; macquarie university, nsw 2109 ; AS 2109
• Manufacturer Contact: yaneesa vetsandonphong ; unit ug-1 vertical podium; no. 8 jalan kerinchi; kuala lumpur, wilayah persekutuan 59200 ; MY 59200
• MDR Report Key: 12866867
• MDR Text Key: 281191172
• Report Number: 6000034-2021-03592
• Device Sequence Number: 1
• Product Code: MCM
• UDI-Device Identifier: 09321502032599
• UDI-Public: (01)09321502032599(11)180414(17)200413
• Combination Product (y/n): N
• Reporter Country Code: SA
• PMA/PMN Number: P970051
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Distributor
• Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date: 04/05/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Expiration Date: 04/13/2020
• Device Model Number: CI522
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 11/05/2021
• Initial Date FDA Received: 11/24/2021
• Supplement Dates Manufacturer Received: 01/11/2022; 04/05/2022
• Supplement Dates FDA Received: 02/03/2022; 04/28/2022
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 04/14/2018
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Other; Required Intervention
• Patient Age: 6 YR
• Patient Sex: Male