MAUDE Adverse Event Report: DEPUY IRELAND - 9616671 ATTUNE CR FB INSRT SZ 8 7MM; KNEE IMPLANT

Catalog Number	151620807
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Edema (1820); Pain (1994)
Date of Event	11/18/2017
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Event or Problem Description
Der states that the patient fell and experienced pain with edema on the left leg.It was also indicated that the patient undergone i&d.Doi: (b)(6) 2017; dor: (b)(6) 2017 left knee.
Additional Manufacturer Narrative
Investigation summary :no device associated with this report was received for examination.Depuy synthes considers the investigation closed.Should additional information be received, the information will be reviewed and the investigation may be re-opened as necessary.If information is obtained that was not available for the initial medwatch , a follow-up medwatch, will be filed as appropriate.

• Brand Name: ATTUNE CR FB INSRT SZ 8 7MM
• Common Device Name: KNEE IMPLANT
• Manufacturer (Section D): DEPUY IRELAND - 9616671; loughbeg ringaskiddy co.; cork MA ; EI
• MDR Report Key: 7116593
• Report Number: 1818910-2017-51622
• Device Sequence Number: 19147438
• Product Code: JWH
• UDI-Device Identifier: 10603295046028
• UDI-Public: 10603295046028
• Combination Product (Y/N): N
• Initial Reporter State: FL
• PMA/510(K) Number: K101433
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Health Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/18/2017

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 Catalogue Number: 151620807
• Device Lot Number: 560241
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 11/18/2017
• Supplement Date Received by Manufacturer: 08/30/2018
• Initial Report FDA Received Date: 12/14/2017
• Supplement Report FDA Received Date: 09/06/2018
• 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