MAUDE Adverse Event Report: ONKOS SURGICAL ELEOS; COLLAR MODULAR LOCKING RING

Model Number	HR-30000-03M
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	08/27/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The device will not be returned for investigation.The investigation is in progress.When the investigation is complete, a supplemental report will be submitted accordingly.Multiple mdrs were reported for this event: # 3013450937-2021-00209, # 3013450937-2021-00210, # 3013450937-2021-00211, # 3013450937-2021-00212, # 3013450937-2021-00213, # 3013450937-2021-00214, # 3013450937-2021-00215, # 3013450937-2021-00217.
Event or Problem Description
It was reported that the patient underwent a revision surgery on (b)(6) 2021 due to an alleged infection.The following part were removed and revised: distal femur axial pin, tibial hinge component, tibial poly spacer.The following parts remain implanted from the original eleos surgery which took place on (b)(6) 2021: tibial baseplate, distal femur, stem extension, collar, collar locking ring, and cemented stem.The surgeon removed implants with poly components and performed incision and drainage.No further information was made available.
Additional Manufacturer Narrative
This report is being submitted to include additional information.The investigation is complete.The device was not returned for evaluation.The root cause of the alleged infection could not be determined.The device history records and sterilization batch records were reviewed and no issues during manufacturing or sterilization were identified that could have contributed to this complaint.If any additional information is obtained, a supplemental mdr will be filed accordingly.
Event or Problem Description
It was reported that the patient underwent a revision surgery on (b)(6) 2021 due to an alleged infection.The following part were removed and revised: distal femur axial pin, tibial hinge component, tibial poly spacer.The following parts remain implanted from the original eleos surgery which took place on (b)(6) 2021: tibial baseplate, distal femur, stem extension, collar, collar locking ring, and cemented stem.The surgeon removed implants with poly components and performed incision and drainage.No further information was made available.

• Brand Name: ELEOS
• Common Device Name: COLLAR MODULAR LOCKING RING
• Manufacturer (Section D): ONKOS SURGICAL; 77 east halsey rd; parsippany NJ 07054
• Manufacturer (Section G): PHILLIPS PRECISION INC.; 7 paul kohner pl; elmwood park NJ 07407
• Manufacturer Contact: sara dailey ; 77 east halsey road; parsippany, NJ 07054
• MDR Report Key: 12523080
• Report Number: 3013450937-2021-00216
• Device Sequence Number: 14478732
• Product Code: KRO
• UDI-Device Identifier: B278HR3000003M0
• UDI-Public: +B278HR3000003M0
• Combination Product (Y/N): N
• Initial Reporter State: NE
• Initial Reporter Country: US
• PMA/510(K) Number: K203815
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/22/2021

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?: No
• Operator of Device: Health Professional
• Device Model Number: HR-30000-03M
• Device Catalogue Number: HR-30000-03M
• Device Lot Number: 83914R-017
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/27/2021
• Supplement Date Received by Manufacturer: 11/22/2021
• Initial Report FDA Received Date: 09/23/2021
• Supplement Report FDA Received Date: 11/22/2021
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 05/01/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: P/N 25000007E, ELEOS DISTAL FEMUR; P/N 25001212E, ELEOS TIBIAL POLY SPACER; P/N 25002111E, ELEOS DISTAL FEMUR AXIAL PIN; P/N 25002202E, ELEOS TIBIAL BASEPLATE; P/N HC-11120-03M, ELEOS CEMENTED STEM; P/N KSC01530E, ELEOS STEM EXTENSION, 15X30MM; P/N SB-3640V-03M, ELEOS COLLAR, 36/40MM; P/N THSMWRS01M, ELEOS TIBIAL HINGE COMPONENT; P/N 25000007E, ELEOS DISTAL FEMUR; P/N 25001212E, ELEOS TIBIAL POLY SPACER; P/N 25002111E, ELEOS DISTAL FEMUR AXIAL PIN; P/N 25002202E, ELEOS TIBIAL BASEPLATE; P/N HC-11120-03M, ELEOS CEMENTED STEM; P/N KSC01530E, ELEOS STEM EXTENSION, 15X30MM; P/N SB-3640V-03M, ELEOS COLLAR, 36/40MM; P/N THSMWRS01M, ELEOS TIBIAL HINGE COMPONENT
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Sex: Female