MAUDE Adverse Event Report: ONKOS SURGICAL ELEOS; CEMENTED SEGMENTAL STEM, 15X120MM

Model Number	CS-15120-03M
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	02/27/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
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 there were no non-conformances identified that would have contributed to this adverse event.If any additional information is obtained, a supplemental mdr will be filed accordingly.This mdr was originally assigned #3013450937-2023-00044 and was submitted for this adverse event on 24 march 2023, however, webtrader identified that this was assigned a duplicate mfr report number.Therefore, this report, is being submitted to correct the duplicate.Multiple mdrs were submitted for this event: #3013450937-2023-00045, #3013450937-2023-00046, #3013450937-2023-00047, #3013450937-2023-00048, #3013450937-2023-00049, and #3013450937-2023-00050.The following mdrs were submitted for the same patient: #3013450937-2020-00059, #3013450937-2020-00060, #3013450937-2020-00061, and #3013450937-2020-00062.
Event or Problem Description
It was reported that the patient developed an alleged infection.The patient underwent a revision surgery on (b)(6) 2023 where the following eleos implants were revised: distal femur, tibial hinge component, poly spacer, and distal femur axial pin.The following eleos implants remained implanted during the revision surgery: segmental stem, tibial baseplate, and stem extension.No additional information regarding this adverse event has been reported.

• Brand Name: ELEOS
• Common Device Name: CEMENTED SEGMENTAL STEM, 15X120MM
• 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: sara dailey ; 77 east halsey road; parsippany, NJ 07054 ; 9732645400
• MDR Report Key: 16624616
• Report Number: 3013450937-2023-00051
• Device Sequence Number: 14685444
• Product Code: KRO
• UDI-Device Identifier: B278CS1512003M0
• UDI-Public: B278CS1512003M0
• Combination Product (Y/N): N
• Initial Reporter State: SC
• Initial Reporter Country: US
• PMA/510(K) Number: K161520
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 03/27/2023

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 Expiration Date: 01/18/2024
• Device Model Number: CS-15120-03M
• Device Catalogue Number: CS-15120-03M
• Device Lot Number: 81680
• 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: 03/24/2023
• Initial Report FDA Received Date: 03/27/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 01/18/2019
• 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 25000009E, ELEOS DISTAL FEMUR.; P/N 25001210E, ELEOS TIBIAL POLY SPACER.; P/N 25002100E, ELEOS TIBIAL HINGE COMPONENT.; P/N 25002111E, ELEOS DISTAL FEMUR AXIAL PIN.; P/N 25002204E, ELEOS TIBIAL BASEPLATE.; P/N KSC01530E, ELEOS STEM EXTENSION.
• Outcome Attributed to Adverse Event: Hospitalization
• Patient Age: 86 YR
• Patient Sex: Female