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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDACTA INTERNATIONAL SA COCR BALL HEAD 12/14 Ø 28 SIZE L +3.5; METALLIC BALL HEAD
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MEDACTA INTERNATIONAL SA COCR BALL HEAD 12/14 Ø 28 SIZE L +3.5; METALLIC BALL HEAD Back to Search Results
Catalog Number 01.25.013
Health Effect - Clinical Code Unspecified Infection (1930)
Date of Event 09/08/2017
Type of Reportable Event Serious Injury
Additional Manufacturer Narrative
Batch review performed on 02 october 2017.Lot 166592: (b)(4) items manufactured and released on 07 march 2017.Expiration date: 2022-02-21.No anomalies found related to the problem.To date, (b)(4) items of the same lot have been already sold without any similar reported event.
 
Event or Problem Description
The patient came in due to signs of infection.The surgeon revised the head.The surgery was completed successfully.
 
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Brand Name
COCR BALL HEAD 12/14 Ø 28 SIZE L +3.5
Common Device Name
METALLIC BALL HEAD
Manufacturer (Section D)
MEDACTA INTERNATIONAL SA
strada regina
castel san pietro, 6874
SZ  6874
MDR Report Key6921489
Report Number3005180920-2017-00559
Device Sequence Number19045574
Product Code JDI
UDI-Device Identifier07630030805127
UDI-Public07630030805127
Combination Product (Y/N)N
Initial Reporter StateIL
Initial Reporter CountryUS
PMA/510(K) Number
K072857
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2017
Device Explanted Year2017
Reporter Type Manufacturer
Report Source company representative
Initial Reporter Occupation Other
Type of Report Initial
Report Date (Section B) 10/06/2017
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 Date02/21/2022
Device Catalogue Number01.25.013
Device Lot Number166592
Was Device Available for Evaluation? No
Was the Report Sent to FDA? No
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 09/08/2017
Initial Report FDA Received Date10/06/2017
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)		 No
Patient Sequence Number1
Outcome Attributed to Adverse Event Required Intervention;
Patient Age70 YR
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