MAUDE Adverse Event Report: CONFORMIS, INC. ITOTAL IDENTITY CR; TOTAL KNEE REPLACEMENT SYSTEM

Model Number TCR101111201

Device Problem Material Too Rigid or Stiff (1544)

Patient Problem Insufficient Information (4580)

Event Date 12/01/2020

Event Type  Injury  

Manufacturer Narrative

It was reported that the patient has a stiff knee.Revision surgery is planned to debride the knee and exchange the poly inserts.Review of the device history record indicates that the device was manufactured to specification.

Event Description

It was reported that the patient has a stiff knee.Revision surgery is planned to debride the knee and exchange the poly inserts.

• Brand Name: ITOTAL IDENTITY CR
• Type of Device: TOTAL KNEE REPLACEMENT SYSTEM
• Manufacturer (Section D): CONFORMIS, INC.; 600 technology park drive; billerica MA 01821
• Manufacturer (Section G): CONFORMIS, INC.; 600 research drive; wilmington MA 01887
• Manufacturer Contact: emmanuel nyakako ; 600 technology park drive; billerica, MA 01821 ; 7813459164
• MDR Report Key: 11158792
• MDR Text Key: 226539720
• Report Number: 3004153240-2021-00001
• Device Sequence Number: 1
• Product Code: JWH
• UDI-Device Identifier: M572TCR1011112011
• UDI-Public: +M572TCR1011112011
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K192198
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 01/12/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/13/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: TCR101111201
• Device Catalogue Number: TCR-101-1112
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 12/14/2020
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 03/31/2020
• 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): Required Intervention
• Patient Age: 51 YR