MAUDE Adverse Event Report: MICROPORT ORTHOPEDICS INC. TIB BASE COCR NON POR SZ 5 IMPLANT PARTNERS?; KNEE COMPONENT

Model Number KTCCNP30WD

Device Problem Patient-Device Incompatibility (2682)

Patient Problem Hypersensitivity/Allergic reaction (1907)

Event Type  Injury  

Manufacturer Narrative

This event will be updated once the investigation is complete.Trends will be evaluated.

Event Description

Allegedly, the patient is presenting an allergic reaction on both knees.

• Brand Name: TIB BASE COCR NON POR SZ 5 IMPLANT PARTNERS?
• Type of Device: KNEE COMPONENT
• Manufacturer (Section D): MICROPORT ORTHOPEDICS INC.; 5677 airline rd.; arlington TN 38002
• Manufacturer (Section G): MICROPORT ORTHOPEDICS INC.; 5677 airline rd.; arlington TN 38002
• Manufacturer Contact: 5677 airline road; arlington, TN 38002 ; 9018674771
• MDR Report Key: 13535645
• MDR Text Key: 285664691
• Report Number: 3010536692-2022-00048
• Device Sequence Number: 1
• Product Code: HRY
• UDI-Device Identifier: M684KTCCNP30WD1
• UDI-Public: M684KTCCNP30WD1
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K960617
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 04/13/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/15/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Other
• Device Model Number: KTCCNP30WD
• Device Catalogue Number: KTCCNP30WD
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Distributor Facility Aware Date: 01/26/2022
• Date Manufacturer Received: 01/26/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention