MAUDE Adverse Event Report: CONFORMIS, INC. IUNI G2; UNICOMPARTMENTAL KNEE REPLACEMENT SYSTEM

Catalog Number UKA-111-1111

Device Problem Loose or Intermittent Connection (1371)

Patient Problem Fall (1848)

Event Date 07/01/2016

Event Type  Injury  

Manufacturer Narrative

Femoral implant loosening was reported following patient fall.Revision surgery is planned.Review of the device history record indicates that the device was manufactured to specification.

Event Description

Femoral implant loosening was reported following patient fall.Revision surgery is planned.

• Brand Name: IUNI G2
• Type of Device: UNICOMPARTMENTAL KNEE REPLACEMENT SYSTEM
• Manufacturer (Section D): CONFORMIS, INC.; 28 crosby drive; bedford MA 01730
• Manufacturer (Section G): CONFORMIS, INC.; 600 research drive; wilmington MA 01887
• Manufacturer Contact: karina snow ; 28 crosby drive; bedford, MA 01730 ; 7813459195
• MDR Report Key: 5836213
• MDR Text Key: 50819336
• Report Number: 3004153240-2016-00153
• Device Sequence Number: 1
• Product Code: HSX
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K111916
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 08/01/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/01/2016
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Physician
• Device Expiration Date: 04/30/2016
• Device Catalogue Number: UKA-111-1111
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 07/05/2016
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 10/08/2015
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 50 YR