MAUDE Adverse Event Report: ONKOS SURGICAL ELEOS; CANAL-FILLING SEGMENTAL STEM, BOWED, 11X152MM

Model Number	FB-11152-03M
Medical Device Problem Code	Loosening of Implant Not Related to Bone-Ingrowth (4002)
Health Effect - Clinical Code	Pain (1994)
Date of Event	03/02/2023
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that the patient was experiencing pain in their thigh.Through an x-ray, it was suspected that there was loosening of the patient's canal-filling segmental stem.The patient underwent a revision surgery on (b)(6), 2023 where the 11x152mm canal-filling bowed segmental stem was revised to a 14x152mm canal-filling bowed segmental stem.During the revision surgery, the following eleos implants were also revised: distal femur, tibial hinge component, distal femur axial pin, male-female midsection, and tibial poly spacer.There were no alleged malfunctions with the distal femur, tibial hinge component, distal femur axial pin, male- female midsection, and tibial poly spacer.No additional information regarding this adverse event has been reported.
Additional Manufacturer Narrative
The investigation is in process.When the investigation is complete, a supplemental mdr will be submitted accordingly.
Event or Problem Description
It was reported that the patient was experiencing pain in their thigh.Through an x-ray, it was suspected that there was loosening of the patient's canal-filling segmental stem.The patient underwent a revision surgery on (b)(6) 2023 where the 11x152mm canal-filling bowed segmental stem was revised to a 14x152mm canal-filling bowed segmental stem.During the revision surgery, the following eleos implants were also revised: distal femur, tibial hinge component, distal femur axial pin, male-female midsection, and tibial poly spacer.There were no alleged malfunctions with the distal femur, tibial hinge component, distal femur axial pin, male-female midsection, and tibial poly spacer.No additional information regarding this adverse event has been reported.
Additional Manufacturer Narrative
This report is being submitted to include additional information.The investigation is complete.The device was not returned for evaluation.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.

• Brand Name: ELEOS
• Common Device Name: CANAL-FILLING SEGMENTAL STEM, BOWED, 11X152MM
• 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
• MDR Report Key: 16637779
• Report Number: 3013450937-2023-00052
• Device Sequence Number: 12099106
• Product Code: KRO
• UDI-Device Identifier: B278FB1115203M0
• UDI-Public: B278FB1115203M0
• Combination Product (Y/N): N
• Initial Reporter State: TX
• 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: 2023
• 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): 04/27/2023

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 Model Number: FB-11152-03M
• Device Catalogue Number: FB-11152-03M
• Device Lot Number: 86823
• 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: 03/02/2023
• Supplement Date Received by Manufacturer: 04/27/2023
• Initial Report FDA Received Date: 03/29/2023
• Supplement Report FDA Received Date: 04/27/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 04/23/2020
• 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 25001070E, ELEOS MALE FEMALE MIDSECTION; P/N 25001208E, ELEOS POLY SPACER; P/N 25002111E, ELEOS DISTAL FEMUR AXIAL PIN; P/N KSP11100E, ELEOS STEM EXTENSION; P/N TB-2204E-01M, ELEOS TIBIAL BASEPLATE; P/N TB-TSCRW-01M, ELEOS TIBIAL BASEPLATE SCREW; P/N THSMWOS01M, ELEOS TIBIAL HINGE COMPONENT
• Outcome Attributed to Adverse Event: Hospitalization
• Patient Age: 17 YR
• Patient Sex: Male