MAUDE Adverse Event Report: ONKOS SURGICAL ELEOS; MODULAR POROUS BIOGRIP HA COLLAR, 28MM

Model Number	PB-2800R-03M
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	06/05/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The investigation is in process.The device will not be returned for evaluation.When the investigation is complete, a supplemental mdr will be submitted accordingly.Multiple mdrs were submitted for this event: #3013450937-2023-00115, #3013450937-2023-00116, #3013450937-2023-00118 and #3013450937-2023-00119.
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 implant was revised: femoral head.A different company's bipolar shell implant was also revised during this procedure.The following eleos implants remain implanted: proximal femur, segmental stem, biogrip collar, and collar locking ring.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 there were no non-conformances identified that would have contributed to this complaint.If additional information is obtained, a supplemental mdr will be filed accordingly.The following sections were updated: 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 4110: trend analysis; h6: type of investigation code updated to 4109: historical data analysis; h6: investigation findings code updated to 3221: no findings available; h6: investigation conclusions code updated to 4315: cause not established.
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 implant was revised: femoral head.A different company's bipolar shell implant was also revised during this procedure.The following eleos implants remain implanted: proximal femur, segmental stem, biogrip collar, and collar locking ring.No additional information regarding this adverse event has been reported.

• Brand Name: ELEOS
• Common Device Name: MODULAR POROUS BIOGRIP HA COLLAR, 28MM
• 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 ; 8447672766
• MDR Report Key: 17264148
• Report Number: 3013450937-2023-00117
• Device Sequence Number: 18134274
• Product Code: JDI
• UDI-Device Identifier: B278PB2800R03M0
• UDI-Public: B278PB2800R03M0
• Combination Product (Y/N): N
• Initial Reporter State: NC
• Initial Reporter Country: US
• PMA/510(K) Number: K203815
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted 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): 09/01/2023

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: PB-2800R-03M
• Device Catalogue Number: PB-2800R-03M
• Device Lot Number: 92478-062
• 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: 06/05/2023
• Supplement Date Received by Manufacturer: 09/01/2023
• Initial Report FDA Received Date: 07/06/2023
• Supplement Report FDA Received Date: 09/01/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 02/18/2022
• 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: BIPOLAR SHELL IMPLANT.; P/N 26012803E, ELEOS FEMORAL HEAD.; P/N HC-11120-03M, ELEOS SEGMENTAL STEM.; P/N HR-30001-03M, ELEOS COLLAR LOCKING RING.; P/N PF-2000L-02M, ELEOS PROXIMAL FEMUR.
• Outcome Attributed to Adverse Event: Hospitalization
• Patient Age: 67 YR
• Patient Sex: Female