MAUDE Adverse Event Report: EXACTECH, INC. EQUINOXE REVERSE TRAY ADAPTER PLATE TRAY +0; ADAPTER TRAY

Catalog Number 320-10-00

Device Problem Microbial Contamination of Device (2303)

Patient Problems Unspecified Infection (1930); Pain (1994)

Event Date 11/27/2018

Event Type  Injury  

Manufacturer Narrative

Pending evaluation.

Event Description

Dr.(b)(6) revised a shoulder that was infected and the patient was complaining of pain.The patient's health was stable as they left the operating room.

Manufacturer Narrative

The revision reported was likely the result of infection, which led to pain.

• Brand Name: EQUINOXE REVERSE TRAY ADAPTER PLATE TRAY +0
• Type of Device: ADAPTER TRAY
• Manufacturer (Section D): EXACTECH, INC.; 2320 nw 66th court; gainesville FL 32653
• MDR Report Key: 8120581
• MDR Text Key: 128917226
• Report Number: 1038671-2018-00907
• Device Sequence Number: 1
• Product Code: KWT
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 01/17/2019

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 Catalogue Number: 320-10-00
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 11/28/2018
• Initial Date FDA Received: 11/30/2018
• Supplement Dates Manufacturer Received: 11/28/2018
• Supplement Dates FDA Received: 01/17/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 63 YR
• Patient Weight: 128