MAUDE Adverse Event Report: ARTOSS GMBH NANOBONE SBX PUTTY; BONE VOID FILLER

Model Number	200046
Medical Device Problem Code	Migration (4003)
Health Effect - Clinical Code	Hematoma (1884)
Date of Event	05/11/2020
Type of Reportable Event	Serious Injury
Event or Problem Description
This emdr was originally submitted in august 2020 with a follow-up in september 2020.It was later discovered that those reports apparently did not upload into fda's emdr system correctly.Accordingly, they are being consolidated and submitted again here to make sure the reported information is in the emdr system as required.Specifically: a report of possible migration of a portion of the nanobone sbx putty and /or infection of the surgical site was received from a physician's assistant.Patient was operated on for one level lumbar spinal fusion.Patient experienced excessive post-op edema and pain at surgery site.At two week follow-up visit, incision was reopened and some nanobone bone graft appeared to have migrated from the implantation site to beneath the skin.Incision was washed out, then closed and edema and pain resolved.

• Brand Name: NANOBONE SBX PUTTY
• Common Device Name: BONE VOID FILLER
• Manufacturer (Section D): ARTOSS GMBH; fischerweg 421; rostock, 18069 ; GM 18069
• MDR Report Key: 17695597
• Report Number: 3011484392-2020-00005
• Device Sequence Number: 17687068
• Product Code: MQV
• UDI-Device Identifier: 14260418440468
• UDI-Public: (01)14260418440468(10)004823(17)221008
• Combination Product (Y/N): N
• Initial Reporter State: NV
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2020
• Serviced by Third Party (Y/N): N
• Reporter Type: Importer
• Initial Reporter Occupation: Physician Assistant
• Type of Report: Initial
• Report Date (Section B): 08/06/2020
• Report Date (Section F): 08/06/2020

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: 10/08/2022
• Device Model Number: 200046
• Device Catalogue Number: 200046
• Device Lot Number: 004823
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 07/06/2020
• Device Age: 7 MO
• Event Location: Hospital
• Date Report to Manufacturer: 08/06/2020
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 09/06/2023
• 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 Age: 50 YR
• Patient Sex: Male
• Patient Weight: 64 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: Black Or African American, White
• Date Report Sent to FDA: 08/06/2020