Brand Name | INBONE® |
Type of Device | PROSTHESIS, ANKLE, SEMI-CONSTRAINED, CEMENTED, METAL/POLYMER |
Manufacturer (Section D) |
WRIGHT MEDICAL TECHNOLOGY, INC. |
11576 memphis arlington rd |
38002 |
|
Manufacturer (Section G) |
WRIGHT MEDICAL TECHNOLOGY, INC. |
11576 memphis arlington rd |
|
38002 |
|
Manufacturer Contact |
timothy
nickel
|
1023 cherry road |
901451-631
|
|
MDR Report Key | 6368320 |
MDR Text Key | 69016608 |
Report Number | 1043534-2017-00024 |
Device Sequence Number | 1 |
Product Code |
HSA
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K133585 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
02/06/2017 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/01/2017 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Other
|
Device Expiration Date | 02/01/2022 |
Device Model Number | 200012902 |
Device Lot Number | 1538367 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 06/07/2017 |
Is the Reporter a Health Professional? |
No
|
Distributor Facility Aware Date | 02/06/2017 |
Event Location |
Other
|
Date Manufacturer Received | 02/06/2017 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 02/01/2014 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Age | 46 YR |
|
|