MAUDE Adverse Event Report: ONKOS SURGICAL ELEOS; CEMENTED SEGMENTAL STEM SIZE: 13MM X 120MM, STRAIGHT, FLUTED, 28MM COLLAR

Model Number	CS-13120-03M
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Unspecified Infection (1930); Insufficient Information (4580)
Date of Event	07/26/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The investigation is in progress.When it is complete a supplemental mdr will be submitted accordingly.Mulitple mdrs were submitted for this adverse event: 3013450937-2022-00220, 3013450937-2022-00221, 3013450937-2022-00222, 3013450937-2022-00223, 3013450937-2022-00224, 3013450937-2022-00225 and 3013450937-2022-00226.
Event or Problem Description
It was reported that a patient experienced an infection and underwent a revision surgery.The following implants were removed during the revision: eleos distal femur axial pin, eleos tibial baseplate, eleos tibial poly spacer, eleos tibial hinge w/ rotational stop, eleos stem extension, eleos distal femur, eleos tibial block augment and eleos cemented segmental stem.
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.On (b)(6) 2022, when completing the investigation, it was identified that two of the initial mdrs that were submitted did not successfully go through as they were assigned duplicate mfr numbers.3013450937-2022-00349 and 3013450937-2022-00348 were submitted for these parts.Multiple mdrs were submitted for this adverse event: 3013450937-2022-00348, 3013450937-2022-0000349, 3013450937-2022-00222, 3013450937-2022-00223, 3013450937-2022-00224, 3013450937-2022-00225 and 3013450937-2022-00226.
Event or Problem Description
It was reported that a patient experienced an infection and underwent a revision surgery.The following implants were removed during the revision: eleos distal femur axial pin, eleos tibial baseplate, eleos tibial poly spacer, eleos tibial hinge w/ rotational stop, eleos stem extension, eleos distal femur, eleos tibial block augment and eleos cemented segmental stem.

• Brand Name: ELEOS
• Common Device Name: CEMENTED SEGMENTAL STEM SIZE: 13MM X 120MM, STRAIGHT, FLUTED, 28MM COLLAR
• Manufacturer (Section D): ONKOS SURGICAL; 77 east halsey road; parsippany NJ 07054
• Manufacturer (Section G): PHILLIPS PRECISION INC.; 7 paul kohner pl; elmwood park NJ 07407
• Manufacturer Contact: danielle pierce ; 77 east halsey road; parsippany 07054 ; 8447672766
• MDR Report Key: 15298675
• Report Number: 3013450937-2022-00227
• Device Sequence Number: 12261536
• Product Code: KRO
• UDI-Device Identifier: B278CS1312003M0
• UDI-Public: B278CS1312003M0
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K161520
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2022
• Device Explanted Year: 2022
• 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): 11/23/2022

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: CS-13120-03M
• Device Catalogue Number: CS-13120-03M
• Device Lot Number: 90742-014
• 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: 07/26/2022
• Supplement Date Received by Manufacturer: 10/24/2022
• Initial Report FDA Received Date: 08/25/2022
• Supplement Report FDA Received Date: 11/23/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/16/2021
• 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: 25000009E ELEOS DISTAL FEMUR SIZE:RIGHT, SEGMENTAL; 25001208E ELEOS TIBIAL POLY SPACER THICKNESS: 8MM; 25002111E ELEOS DISTAL FEMUR AXIAL PIN; KSP10100E ELEOS STEM EXTENSION, CANAL FILLING; KTAGB210E ELEOS TIBIAL BLOCK AUGMENT SIZE: 2; TB-2202E-01M ELEOS SIZE 2 TIBIAL BASEPLATE; THSMWRS01M ELEOS TIBIAL HINGE W/ROTATIONAL STOP
• Outcome Attributed to Adverse Event: Required Intervention; Hospitalization
• Patient Age: 73 YR
• Patient Sex: Female