MAUDE Adverse Event Report: AESCULAP AG VEGA PS GLIDING SURFACE T1/1+ 10MM; KNEE ENDOPROSTHESES

Model Number	NX110
Medical Device Problem Code	Loosening of Implant Not Related to Bone-Ingrowth (4002)
Health Effect - Clinical Code	Joint Laxity (4526)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Investigation results: reference code: nx051z.Device name: as vega ps tibial plateau cemented t1.Serial number: n/a.Batch number: 52106248.Manufacturing date: 09.02.2015.Reference code, device name, corresponding internal notification number.Nx009z as, vega ps femoral comp.Cemented f4n l, 400479820 nx043, patella 3-pegs p3, 400479821.Nx110, vega ps gliding surface t1/1+ 10mm, 400479822.Nn260p, plug f/tibial plateau, 400479823.Investigation: no products available.Therefore a failure description at the products are not possible.Pictorial documentation: there are no pictures available.Batch history review: the device quality and manufacturing history records (dhr) have been checked for all available lot numbers and the products found to be according to our specification valid at the time of production.There are 1 similar complaints against the same lot number(s).Lot number 52082622: cc 400476564.Explanation and rationale: no products available and therefore it is hardly possible to determine an exact conclusion and root cause.The exact cause cannot be determined.Corrective action: for this topic (implant loosening) a product safety case (psc) was initiated.
Event or Problem Description
It was reported to aesculap inc.That a vega knee implant system was implanted during a primary surgery performed on (b)(6) 2015.According to the complainant, following the primary surgery, the patient experienced loosening of the implant.The patient underwent a revision surgery occurred on (b)(6) 2017.The complaint device was not available to be returned to the manufacturer for evaluation.All available information has been provided at this time, if additional information becomes available the complaint will be updated accordingly.The adverse event / malfunction is filed under reference xc (b)(4).Involved components: nx009z (ps femur cemented f4n lt), nx043 (universal patella p3), nx110 (ps pe insert t1/t1+, 10mm), nn260p (peek plug f/ tibia), nx051z (ps tibia cemented t1).The cement used is unidentified.Associated medwatches: 2916714-2020-00329, 2916714-2020-00330, 2916714-2020-00331, 2916714-2020-00332, 2916714-2020-00333.

• Brand Name: VEGA PS GLIDING SURFACE T1/1+ 10MM
• Common Device Name: KNEE ENDOPROSTHESES
• Manufacturer (Section D): AESCULAP AG; po box 40; tuttlingen, 78501 ; GM 78501
• MDR Report Key: 11527805
• Report Number: 2916714-2020-00331
• Device Sequence Number: 5350042
• Product Code: JWH
• UDI-Device Identifier: 04046963810764
• UDI-Public: 4046963810764
• Combination Product (Y/N): N
• Initial Reporter State: FL
• 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
• Report Date (Section B): 03/19/2021
• Report Date (Section F): 03/19/2021

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 Expiration Date: 05/01/2018
• Device Model Number: NX110
• Device Catalogue Number: NX110
• Device Lot Number: 51949661
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 07/20/2018
• Event Location: Hospital
• Date Report to Manufacturer: 07/20/2018
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 03/19/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Date Report Sent to FDA: 03/19/2021