MAUDE Adverse Event Report: EBI, LLC. SFLX - COILETTE

Model Number N/A

Device Problems Patient-Device Incompatibility (2682); Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Hypersensitivity/Allergic reaction (1907); Pain (1994); Discomfort (2330); Swelling/ Edema (4577)

Event Type  Injury  

Manufacturer Narrative

Zimvie complaint (b)(4).Date of event: the event occurred sometime in (b)(6) 2022.Medical product: unknown.Therapy date: unknown.Customer has indicated that the product is in process of being returned to zimvie for investigation.Once the investigation is complete, a supplemental medwatch 3500a will be submitted.

Event Description

It was reported that the patient experienced an allergic reaction while she was treating with the bone healing system.The patient stated that she has a copper allergy.The patient¿s bhs controller and coil make her foot swell up and cause discomfort.It was later reported on (b)(6) 2022, that the patient confirmed the coil used was a slfx coilette.The patient further advised she had a full body allergic reaction to the bhs.The skin on her whole body was itchy.The patient did not experience redness, blisters, welts, no other skin issues, or pain.The patient was advised by her physician to discontinue treatment with the bone healing system, and she would be switched to an ortho pak assembly.No additional patient consequences have been reported.

Manufacturer Narrative

This follow-up report is being submitted to relay additional information.The device not was returned to zimvie for investigation.The reported event was not verifiable after the investigation associated with allergic reaction, swelling, and discomfort.The device history record was reviewed and no discrepancies related to the reported event were found.No physical and/or functional condition could be found after the dhr that could be considered a causal factor for the reported complaint.If any further information is found which would change or alter any conclusions or information, a supplemental report will be filed accordingly zimvie will continue to monitor for trends.

Event Description

It was reported that the patient experienced an allergic reaction while she was treating with the bone healing system.The patient stated that she has a copper allergy.The patient¿s bhs controller and coil make her foot swell up and cause discomfort.It was later reported on aug 5, 2022, that the patient confirmed the coil used was a slfx coilette.The patient further advised she had a full-body allergic reaction to the bhs.The skin on her whole body was itchy.The patient did not experience redness, blisters, welts, no other skin issues, or pain.The patient was advised by her physician to discontinue treatment with the bone healing system, and she would be switched to an ortho pak assembly.No additional patient consequences have been reported.

• Brand Name: SFLX - COILETTE
• Type of Device: COIL
• Manufacturer (Section D): EBI, LLC.; 1 gatehall dr; parsippany NJ 07054
• Manufacturer (Section G): EBI, LLC.; 1 gatehall dr; parsippany NJ 07054
• Manufacturer Contact: stephanie smith ; 1 gatehall dr; parsippany, NJ 07054 ; 9732999300
• MDR Report Key: 15289273
• MDR Text Key: 298563542
• Report Number: 0002242816-2022-00097
• Device Sequence Number: 1
• Product Code: LOF
• UDI-Device Identifier: 00812301020607
• UDI-Public: 00812301020607
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P790002/S026
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Consumer
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date: 03/23/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/24/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Lay User/Patient
• Device Model Number: N/A
• Device Catalogue Number: 1068238
• Device Lot Number: N/A
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 03/21/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Removal/Correction Number: N/A
• Patient Sequence Number: 1
• Treatment: SEE H10 NARRATIVE
• Patient Outcome(s): Required Intervention
• Patient Sex: Female