| Brand Name | INFINITY TIBIAL TRAY SIZE 3 TOTAL ANKLE SYSTEM |
| Common Device Name | PROSTHESIS, ANKLE, SEMI-CONSTRAINED, CEMENTED, METAL/POLYMER |
| Manufacturer (Section D) |
| WRIGHT MEDICAL TECHNOLOGY INC |
| 1023 cherry rd |
| memphis TN 38117 |
|
| Manufacturer (Section G) |
| WRIGHT MEDICAL TECHNOLOGY, INC. |
| 11576 memphis arlington rd |
|
| arlington TN 38002 |
|
| Manufacturer Contact |
|
dannielle
stap
|
| 325 corporate drive |
| mahwah, NJ 07430
|
|
2018315000
|
|
| MDR Report Key | 22963519 |
| Report Number | 3010667733-2025-01016 |
| Device Sequence Number | 12826924 |
| Product Code |
HSN
|
| UDI-Device Identifier | 00840420122506 |
| UDI-Public | (01)00840420122506(11)190117(17)270115(10)1642779 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | UK |
| PMA/510(K) Number | K140749 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2019 |
| Device Explanted Year | 2025 |
| Reporter Type |
Manufacturer
|
| Report Source |
Other,Study |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/04/2025 |
| 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 |
Lay User/Patient
|
| Device Catalogue Number | 33650003 |
| Device Lot Number | 1642779 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Initial |
| Initial Date Received by Manufacturer | 08/15/2025 |
| Initial Report FDA Received Date | 09/04/2025 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 01/17/2019 |
| Is the Device Labeled for Single Use? (Y/N) |
No
|
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 | 74 YR |
| Patient Sex | Female |
|
|