MAUDE Adverse Event Report: STRYKER ORTHOPAEDICS-MAHWAH SCORPIOFLEX TOTAL KNEE PS; PROSTHESIS, KNEE, PATELLOFEMOROTIBIAL, SEMI-CONSTRAINED, CEMENTED, POLYMER/METAL

Catalog Number	72-15-0908
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Unspecified Infection (1930); Injury (2348)
Date of Event	08/17/2018
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Review of the product history records indicate devices were manufactured and accepted into final stock with no relevant reported discrepancies.There have been no other events for the lot referenced.It was noted that the device is not available for evaluation.Should additional information become available, it will be provided in a supplemental report upon completion of the investigation.The following devices were also listed in this report: series 7000 standard tibia; cat#7115-0009; lot#t05w128; scorpio ps femur waffle w/lfit; cat#71-4109l; lot#k05w182; scorpio u-dome patella; cat#73-3708; lot#v288; simplex p half dose 1 pack; cat#6188-1-001; lot#rjm357; simplex p full dose 1 pack; cat#6191-1-001; lot#rkm375; simplex p full dose 1 pack; cat#6191-1-001; lot#rlm383.It cannot be determined which, if any of these devices may have caused or contributed to the patient's experience.
Event or Problem Description
It was reported that patient's left knee was revised due to infection.The poly was exchanged for the same catalog number.Rep provided a primary implant sheet and reported that hospital will release no further information.

• Brand Name: SCORPIOFLEX TOTAL KNEE PS
• Common Device Name: PROSTHESIS, KNEE, PATELLOFEMOROTIBIAL, SEMI-CONSTRAINED, CEMENTED, POLYMER/METAL
• Manufacturer (Section D): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• MDR Report Key: 7876367
• Report Number: 0002249697-2018-02868
• Device Sequence Number: 2217637
• Product Code: JWH
• UDI-Device Identifier: 07613154020287
• UDI-Public: 07613154020287
• Combination Product (Y/N): N
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: K041591
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2006
• Device Explanted Year: 2018
• Reporter Type: Manufacturer
• Report Source: health professional,other
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 09/14/2018

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 Expiration Date: 05/31/2010
• Device Catalogue Number: 72-15-0908
• Device Lot Number: 1ZCXN
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/17/2018
• Initial Report FDA Received Date: 09/14/2018
• 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: Hospitalization; Required Intervention
• Patient Age: 80 YR
• Patient Weight: 142