MAUDE Adverse Event Report: SMITH & NEPHEW, INC. JOURNEY TIBIA BASE NP RT SZ 6; PRSTHSIS,KNEE,PATLLOFMROTIBL,SMI-CNSTRND,CMNTD,PLYMR/MTAL/PLYMR

Catalog Number	74022216
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Injury (2348)
Date of Event	08/31/2017
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that patient had a knee aspiration due to persistent pain and knee is turning black.
Additional Manufacturer Narrative
The associated complaint devices were not returned.The clinical/medical team concluded, based on the submitted xray images and limited information provided the root cause of the persistent knee pain cannot be concluded.Additionally, without the results of the knee aspirations we are unable to rule out an infection as a contributory factor.The reported color change may be related to hyperpigmentation which is a known phenomenon post cutaneous trauma/ injury (i.E.Surgical incisions, scrapes and any injury causing scarring or inflammatory response).The patient impact beyond the reported pain cannot be determined.No further medical investigation can be rendered at this time.A review of the production documentation for the corresponding products did not reveal any deviation from the standard manufacturing processes.A review of complaint history for the listed parts revealed no prior complaints for the listed batches.Without the actual product involved, our investigation cannot proceed.If the device or new information is received in the future, this complaint can be re-opened.

• Brand Name: JOURNEY TIBIA BASE NP RT SZ 6
• Common Device Name: PRSTHSIS,KNEE,PATLLOFMROTIBL,SMI-CNSTRND,CMNTD,PLYMR/MTAL/PLYMR
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• MDR Report Key: 8347855
• Report Number: 1020279-2019-00615
• Device Sequence Number: 1867128
• Product Code: JWH
• UDI-Device Identifier: 03596010554307
• UDI-Public: 03596010554307
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K042515
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: other
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 06/11/2019

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: 07/12/2026
• Device Catalogue Number: 74022216
• Device Lot Number: 16GM09170
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 01/24/2019
• Supplement Date Received by Manufacturer: 01/24/2019
• Initial Report FDA Received Date: 02/18/2019
• Supplement Report FDA Received Date: 06/11/2019
• 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: Other; Required Intervention