MAUDE Adverse Event Report: ENCORE MEDICAL, L.P. EPIK KNEE; EPIK UNI FEMUR 6 L MEDIAL/R LATERAL

Catalog Number 200-01-106

Device Problem Device Slipped (1584)

Patient Problem No Code Available (3191)

Event Date 05/21/2014

Event Type  Injury  

Event Description

Revision surgery - due to the implant loosening.

Manufacturer Narrative

The reason for this revision surgery was identified as device loosening after 8 months of patient use.A review of the device history records showed no non-conforming material reports associated with this product.There was no delay in surgery and another suitable device was available for use.The revision surgery was completed as intended.The device was disposed of at the hospital and not made available to djo surgical for examination.A review of the device history records showed no non-conforming material reports associated with this product.A review of the product complaint report history showed this is the first complaint from this lot.The root cause for the device loosening could not be determined with confidence.There is no information reported that showed a material, design, or manufacturing problem with the product.

• Brand Name: EPIK KNEE
• Type of Device: EPIK UNI FEMUR 6 L MEDIAL/R LATERAL
• Manufacturer (Section D): ENCORE MEDICAL, L.P.; 9800 metric blvd.; austin TX 78758
• Manufacturer (Section G): ENCORE MEDICAL, L.P.; 9800 metric blvd.; austin TX 78758
• Manufacturer Contact: teffany hutto ; 9800 metric blvd.; austin, TX 78758-5445 ; 5128346255
• MDR Report Key: 3840648
• MDR Text Key: 4662752
• Report Number: 1644408-2014-00324
• Device Sequence Number: 1
• Product Code: HRY
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K020741
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 05/21/2014

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?: No
• Device Operator: Health Professional
• Device Expiration Date: 02/28/2015
• Device Catalogue Number: 200-01-106
• Device Lot Number: 53982290
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 08/20/2014
• Initial Date FDA Received: 05/30/2014
• Supplement Dates Manufacturer Received: Not provided
• Supplement Dates FDA Received: 09/12/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 02/12/2009
• 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
• Treatment: (B)(4), LOT 327B1001; (B)(4), LOT A1000002
• Patient Outcome(s): Required Intervention
• Patient Age: 70 YR