MAUDE Adverse Event Report: ONKOS SURGICAL ELEOS; RESURFACING FEMUR AXIAL PIN, SIZE 2

Model Number	25002112E
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	12/23/2021
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that the patient underwent a revision surgery on (b)(6) 2021 due to an alleged infection.During the revision surgery, dr.(b)(6) revised the tibial poly spacer, tibial hinge component, and resurfacing femur axial pin.Dr.(b)(6) performed a washout.The following implants remain implanted from the patient's original surgery on (b)(6) 2021: resurfacing femur, canal-filling stem extension (18x140mm), tibial baseplate, and canal-filling stem extension (18x100mm).No additional information regarding this adverse event has been provided.
Additional Manufacturer Narrative
The investigation is in process.When the investigation is complete, a supplemental mdr will be submitted accordingly.Multiple mdrs were submitted for this event: #3013450937-2022-00022, #3013450937-2022-00023, #3013450937-2022-00024, #3013450937-2022-00025, #3013450937-2022-00026, #3013450937-2022-00027.
Event or Problem Description
It was reported that the patient underwent a revision surgery on (b)(6) 2021 due to an alleged infection.During the revision surgery, dr.(b)(6) revised the tibial poly spacer, tibial hinge component, and resurfacing femur axial pin.Dr.(b)(6) performed a washout.The following implants remain implanted from the patient's original surgery on (b)(6) 2021: resurfacing femur, canal-filling stem extension (16x140mm), tibial baseplate, and canal-filling stem extension (14x100mm).No additional information regarding this adverse event has been provided.
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 would have contributed to this complaint.If any additional information is obtained, a supplemental mdr will be filed accordingly.The following sections were updated: b4: date of this report added.B7: other relevant history updated.G3: date received by manufacturer added.G6: type of report added.H2: follow-up type added.H3: device evaluated by manufacturer updated to no.H6: type of investigation code updated to 3331: analysis of production records.H6: type of investigation code updated to 4111: communication/interviews.H6: type of investigation code updated to 4110: trend analysis.H6: type of investigation code updated to 4114: device not returned.H6: type of investigation code updated to 4117: device not accessible for testing.H6: type of investigation code updated to 4109: historical data analysis.H6: investigation findings code updated to 213: no device problem found.H6: investigation conclusions code updated to 4315: cause not established.H10: additional narratives/data.The following sections were corrected: a1: patient identifier corrected.A2: date of birth corrected.B5: event description corrected.D2: common device name corrected.D4: model number corrected.D4: catalog number corrected.D4: lot number corrected.D4: expiration date corrected.D4: udi corrected.D10: concomitant medical products corrected.H4: device manufacturer date corrected.The following mdrs were also submitted for this patient: 3013450937-2021-00117.3013450937-2021-00118.3013450937-2021-00119.3013450937-2021-00120.3013450937-2021-00121.3013450937-2021-00122.3013450937-2021-00123.

• Brand Name: ELEOS
• Common Device Name: RESURFACING FEMUR AXIAL PIN, SIZE 2
• Manufacturer (Section D): ONKOS SURGICAL; 77 east halsey road; parsippany NJ 07054
• Manufacturer (Section G): MICROPORT ORTHOPEDICS; 5677 airline road; arlington TN 38002
• Manufacturer Contact: sara dailey ; 77 east halsey road; parsippany, NJ 07054
• MDR Report Key: 13307223
• Report Number: 3013450937-2022-00028
• Device Sequence Number: 11680656
• Product Code: KRO
• UDI-Device Identifier: B27825002112E0
• UDI-Public: B27825002112E0
• Combination Product (Y/N): N
• Initial Reporter State: GA
• Initial Reporter Country: US
• PMA/510(K) Number: K161520
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Device Explanted 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): 03/22/2022

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: 25002112E
• Device Catalogue Number: 25002112E
• Device Lot Number: 1826748
• 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: 12/23/2021
• Supplement Date Received by Manufacturer: 03/22/2022
• Initial Report FDA Received Date: 01/20/2022
• Supplement Report FDA Received Date: 03/23/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/18/2019
• 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 25001208E, ELEOS TIBIAL POLY SPACER.; P/N 25001208E, ELEOS TIBIAL POLY SPACER.; P/N 25002101E, ELEOS TIBIAL HINGE COMPONENT.; P/N 25002101E, ELEOS TIBIAL HINGE COMPONENT.; P/N 25002201E, ELEOS TIBIAL BASEPLATE.; P/N 25002201E, ELEOS TIBIAL BASEPLATE.; P/N 2500R002E, ELEOS RESURFACING FEMUR.; P/N 2500R003E, ELEOS RESURFACING FEMUR.; P/N KSP13100E, ELEOS CANAL-FILLING STEM EXTENSION.; P/N KSP15140E, ELEOS CANAL-FILLING STEM EXTENSION.; P/N KSP17100E, ELEOS CANAL-FILLING STEM EXTENSION.; P/N KSP17140E, ELEOS CANAL-FILLING STEM EXTENSION.
• Outcome Attributed to Adverse Event: Required Intervention; Hospitalization
• Patient Age: 61 YR
• Patient Sex: Female