Quick Links: Skip to main page content Skip to Search Skip to Topics Menu Skip to Common Links
  • Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MICROPORT ORTHOPEDICS INC. ADVANCE CANAL FILLING STEM EXTENSION 19MM X 100MM; KNEE COMPONENT
  • Print
  • Share
  • E-mail
-
Super Search Devices@FDA
510(k) | DeNovo | Registration & Listing | Adverse Events | Recalls | PMA | HDE | Classification | Standards
CFR Title 21 | Radiation-Emitting Products | X-Ray Assembler | Medsun Reports | CLIA | TPLC
 

MICROPORT ORTHOPEDICS INC. ADVANCE CANAL FILLING STEM EXTENSION 19MM X 100MM; KNEE COMPONENT Back to Search Results
Model Number KSP18100
Medical Device Problem Codes Loss of Osseointegration (2408); Detachment of Device or Device Component (2907)
Health Effect - Clinical Code No Information (3190)
Date of Event 05/28/2017
Type of Reportable Event Serious Injury
Additional Manufacturer Narrative
This event will be updated once the investigation is complete.Trends will be evaluate.
 
Event or Problem Description
Allegedly, patient was revised due to femur implant fractured at the morse taper, the tibial implant was loose, and there was a dissociation of the tibial stem.
 
Additional Manufacturer Narrative
Please void all reports for medwatch: 3010536692-2020-00434.After further discussion with microport product development, it was concluded that this product could have not been implanted in the patient and would not have been involved in this event.This report should be voided.
 
Search Alerts/Recalls

  New Search  |  Submit an Adverse Event Report

Brand Name
ADVANCE CANAL FILLING STEM EXTENSION 19MM X 100MM
Common Device Name
KNEE COMPONENT
Manufacturer (Section D)
MICROPORT ORTHOPEDICS INC.
5677 airline rd.
arlington TN 38002
MDR Report Key10200800
Report Number3010536692-2020-00434
Device Sequence Number14006345
Product Code JWH
UDI-Device IdentifierM684KSP181001
UDI-PublicM684KSP181001
Combination Product (Y/N)N
Initial Reporter StateWI
Initial Reporter CountryUS
PMA/510(K) Number
K973524
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2016
Device Explanted Year2017
Reporter Type Manufacturer
Report Source other
Initial Reporter Occupation Physician
Type of Report Initial,Followup
Report Date (Section B) 06/26/2020
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
Operator of Device Other
Device Model NumberKSP18100
Device Catalogue NumberKSP18100
Device Lot Number1534919
Was Device Available for Evaluation? No
Was the Report Sent to FDA? No
Distributor Facility Aware Date06/01/2020
Initial Date Received by Manufacturer 06/01/2020
Supplement Date Received by Manufacturer06/01/2020
Initial Report FDA Received Date06/26/2020
Supplement Report FDA Received Date08/06/2020
Patient Sequence Number1
Outcome Attributed to Adverse Event Other; Required Intervention;
-
-