MAUDE Adverse Event Report: COCHLEAR BONE ANCHORED SOLUTIONS AB SP MAGNET 4; COCHLEAR BAHA ATTRACT SYSTEM

Model Number	95774
Medical Device Problem Code	Appropriate Device Problem Term/Code Not Available (3191)
Health Effect - Clinical Code	Tissue Breakdown (2681)
Type of Reportable Event	Serious Injury
Event or Problem Description
Per the clinic, the patient experienced skin breakdown at the magnet site and subsequently was treated with topical antibiotic (specific date and duration not reported).

• Brand Name: SP MAGNET 4
• Common Device Name: COCHLEAR BAHA ATTRACT SYSTEM
• Manufacturer (Section D): COCHLEAR BONE ANCHORED SOLUTIONS AB; konstruktionsvägen 14; mölnlycke, 435 3 3; SW 435 33
• MDR Report Key: 14508033
• Report Number: 6000034-2022-01493
• Device Sequence Number: 19487742
• Product Code: LXB
• UDI-Device Identifier: 09321502028684
• UDI-Public: (01)09321502028684(10)COH1491241(17)310423
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Importer
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 05/03/2022
• Report Date (Section F): 05/26/2022

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: Lay User/Patient
• Device Model Number: 95774
• Device Catalogue Number: 95774
• Device Lot Number: COH1491241
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 05/03/2022
• Event Location: Hospital
• Date Report to Manufacturer: 05/03/2022
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 05/26/2022
• 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
• Patient Sex: Male
• Date Report Sent to FDA: 05/26/2022