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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US PFC*SIGMA C/S NPOR FEM RT SZ 5; SIGMA KNEE PRIMARY : KNEE FEMORAL

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DEPUY ORTHOPAEDICS INC US PFC*SIGMA C/S NPOR FEM RT SZ 5; SIGMA KNEE PRIMARY : KNEE FEMORAL Back to Search Results
Model Number 96-0055
Medical Device Problem Code Difficult to Open or Close (2921)
Health Effect - Clinical Codes Not Applicable (3189); No Code Available (3191)
Date of Event 07/14/2020
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Product complaint # (b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
 
Event or Problem Description
The surgeon was opening the implant but the box was faulty, due this problem the surgeon use other implant of the same size from the hospital and refuse the faulty.
 
Additional Manufacturer Narrative
Product complaint # (b)(4).Investigation summary: the device associated with this report was not received for examination.The investigation could not draw any conclusions about the reported event without the device to examine.Depuy synthes considers the investigation closed at this time.Should additional information be received, the information will be reviewed and the investigation may be re-opened as necessary.No code available is used to capture surgery prolonged and no information available.
 
Additional Manufacturer Narrative
Product complaint #: (b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes joint reconstruction, or its employees that the report constitutes an admission that the product, depuy synthes joint reconstruction, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
 
Event or Problem Description
Additional information received states that the  implant was fixed to the box.It was sterile but when they open the box, they cannot extract it.
 
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Common Device Name
SIGMA KNEE PRIMARY : KNEE FEMORAL
Manufacturer (Section D)
DEPUY ORTHOPAEDICS INC US
700 orthopaedic drive
warsaw IN 46581 0988
MDR Report Key10356581
Report Number1818910-2020-17360
Device Sequence Number16818741
Product Code JWH
UDI-Device Identifier10603295232407
UDI-Public10603295232407
Combination Product (Y/N)N
Initial Reporter CountrySP
PMA/510(K) Number
K950010
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source company representative,distri
Initial Reporter Occupation Other Health Care Professional
Type of Report Initial,Followup,Followup
Report Date (Section B) 07/14/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Operator of Device Health Professional
Device Model Number96-0055
Device Catalogue Number960055
Was Device Available for Evaluation? No
Initial Date Received by Manufacturer 07/14/2020
Supplement Date Received by Manufacturer08/05/2020
08/20/2020
Initial Report FDA Received Date08/03/2020
Supplement Report FDA Received Date08/10/2020
08/21/2020
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Patient Sequence Number1
Concomitant Medical Products
and Therapy/Usage Dates
PFC*SIGMA C/S NPOR FEM RT SZ 5; PFC*SIGMA C/S NPOR FEM RT SZ 5
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