MAUDE Adverse Event Report: AESCULAP AG AS VEGA PS TIBIAL PLATEAU CEMENTED T2+; KNEE ENDOPROSTHESES

Model Number	NX054Z
Medical Device Problem Code	Patient Device Interaction Problem (4001)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/23/2020
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
If additional information or investigation results are made available, they will be provided in a supplemental report.
Event or Problem Description
It was reported that there was an issue with as vega ps tibial plateau.The original implants had been a vega knee system, which later required tibia revision.This initial procedure occurred in (b)(6) 2017.It was noted that no cement adhered to the baseplate.The cement mantle was still complete on tibia.A revision surgery was necessary.Additional information was not provided nor available / was not available.The adverse event is filed under xc reference (b)(4).Involved components: nx221 - vega ps+ gliding surface t2/2+ 12mm - 52351863, palacos r cement.
Additional Manufacturer Narrative
Associated medwatches: 2916714-2020-00708.2916714-2020-00707.
Event or Problem Description
No updates.
Additional Manufacturer Narrative
Manufacturing site evaluation: the device was not returned to the manufacturer for physical evaluation.Additionally, no on-site evaluation of the unit was performed and no parts were returned for failure analysis.Therefore, the investigation was not able to confirm a device issue that could be associated with the reported event.The device history records (dhr) were reviewed for all available lot numbers; the devices were found to be within specification at the time of production.All device history records (dhr) are reviewed and released according to documented procedures and a device is not released if it does not meet requirements or is nonconforming.A definitive conclusion regarding the complaint incident cannot be reached without a physical examination of the complaint device.
Event or Problem Description
No update.

• Brand Name: AS VEGA PS TIBIAL PLATEAU CEMENTED T2+
• Common Device Name: KNEE ENDOPROSTHESES
• Manufacturer (Section D): AESCULAP AG; po box 40; tuttlingen, 78501 ; GM 78501
• MDR Report Key: 11032142
• Report Number: 2916714-2020-00708
• Device Sequence Number: 16442501
• Product Code: JWH
• UDI-Device Identifier: 04046963810436
• UDI-Public: 4046963810436
• Combination Product (Y/N): N
• Initial Reporter State: GA
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Importer
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 02/24/2021
• Report Date (Section F): 12/17/2020

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?: Yes
• Operator of Device: Health Professional
• Device Model Number: NX054Z
• Device Catalogue Number: NX054Z
• Device Lot Number: 52339503
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 11/23/2020
• Device Age: 43 MO
• Event Location: Hospital
• Date Report to Manufacturer: 11/23/2020
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: Not provided; Not provided
• Initial Report FDA Received Date: 12/17/2020
• Supplement Report FDA Received Date: 12/18/2020; 02/25/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: NX221 - BATCH: 52351863
• Outcome Attributed to Adverse Event: Required Intervention
• Date Report Sent to FDA: 12/17/2020