MAUDE Adverse Event Report: DEPUY CMW - 9610921 SMARTSET MV ENDURANCE 80G; BONE CEMENT : BONE CEMENT

Catalog Number	3102080
Medical Device Problem Code	Loss of or Failure to Bond (1068)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	01/14/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that the patient was revised due to the insert had a posterior medial crack in it and patella component was loose.The loosening interface of the patella component is cement/implant.Both were exchanged for new implants.There was no surgical delay and all available information has been disclosed.No further information was provided.Doi: on (b)(6) 2008, dor: on (b)(6) 2025, affected side: left knee.
Additional Manufacturer Narrative
Product complaint#: (b)(4).Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Additional Manufacturer Narrative
Product complaint # (b)(4).Investigation summary: no device associated with this report was received for examination.According to the information received, ¿the patient was revised due to the insert had a posterior medial crack in it and patella component was loose.The loosening interface of the patella component is cement/implant.Both were exchanged for new implants.There was no surgical delay.Doi: (b)(6), 2008.Dor: (b)(6) 2025.Affected side: left knee".Lot: 2610502.Manufacturing date: 08 jul 2011.Expiry date: 30 apr 2011.Quantity: (b)(4).Testing could not be completed as the retained samples are no longer available for testing.There were no non-conformances associated with this batch.All qc and microbiology testing met release specification (ms-007, bone cement: master specification: smartset mv,).As part of our company quality system process, all devices are manufactured, inspected, and distributed to approved specifications.Additional complaint information monitoring for potential safety signals will be conducted through complaint trending as part of the post-market surveillance.If additional information is made available, the investigation will be updated as applicable.Device history lot: lot: 2610502.Manufacturing date: 08 jul 2011.Expiry date: 30 apr 2011.Quantity: (b)(4).Testing could not be completed as the retained samples are no longer available for testing.There were no non-conformances associated with this batch.All qc and microbiology testing met release specification (ms-007, bone cement: master specification: smartset mv,).

• Brand Name: SMARTSET MV ENDURANCE 80G
• Common Device Name: BONE CEMENT : BONE CEMENT
• Manufacturer (Section D): DEPUY CMW - 9610921; cornford rd; cornford rd; cork FY4 4 QQ; UK FY4 4QQ
• Manufacturer (Section G): DEPUY CMW - 9610921; cornford rd; blackpool FY4 4 QQ; UK FY4 4QQ
• Manufacturer Contact: kate karberg ; 700 orthopaedic dr.; warsaw, IN 46581 ; 3035526892
• MDR Report Key: 21257494
• Report Number: 1818910-2025-01685
• Device Sequence Number: 9117252
• Product Code: LOD
• UDI-Device Identifier: 10603295168355
• UDI-Public: (01)10603295168355(17)110430(10)2610502
• Combination Product (Y/N): N
• Initial Reporter State: WA
• Initial Reporter Country: US
• PMA/510(K) Number: K042591
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2008
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 04/30/2011
• Device Catalogue Number: 3102080
• Device Lot Number: 2610502
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 01/15/2025
• Supplement Date Received by Manufacturer: 02/27/2025
• Initial Report FDA Received Date: 01/28/2025
• Supplement Report FDA Received Date: 02/28/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 07/08/2008
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 60 YR
• Patient Sex: Male