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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US LCS COMP RP INSERT STD+ 12.5MM; LCS COMPLETE : KNEE TIBIAL INSERT
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DEPUY ORTHOPAEDICS INC US LCS COMP RP INSERT STD+ 12.5MM; LCS COMPLETE : KNEE TIBIAL INSERT Back to Search Results
Catalog Number 129405512
Medical Device Problem Code Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes Pain (1994); Not Applicable (3189)
Date of Event 04/25/2018
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
Patient was revised to address pain due to instability.Doi: unknown; dor: (b)(6) 2018; left knee.
 
Additional Manufacturer Narrative
Product complaint # : (b)(4).No device associated with this report was received for examination.If information is obtained that was not available for the initial medwatch , a follow-up medwatch, a follow-up medwatch will be filed as appropriate.
 
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Brand Name
LCS COMP RP INSERT STD+ 12.5MM
Common Device Name
LCS COMPLETE : KNEE TIBIAL INSERT
Manufacturer (Section D)
DEPUY ORTHOPAEDICS INC US
700 orthopaedic drive
warsaw IN 46582 0988
MDR Report Key7536929
Report Number1818910-2018-60337
Device Sequence Number1813612
Product Code NJL
UDI-Device Identifier10603295022091
UDI-Public10603295022091
Combination Product (Y/N)N
Initial Reporter StateMI
Initial Reporter CountryUS
PMA/510(K) Number
P830055
Number of Events Summarized1
Summary Report (Y/N)N
Device Explanted Year2018
Reporter Type Manufacturer
Report Source company representative,health
Initial Reporter Occupation Health Professional
Type of Report Initial,Followup
Report Date (Section B) 04/25/2018
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 Number129405512
Was Device Available for Evaluation? No
Initial Date Received by Manufacturer 04/25/2018
Supplement Date Received by Manufacturer06/20/2018
Initial Report FDA Received Date05/23/2018
Supplement Report FDA Received Date06/27/2018
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 Age68 YR
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