MAUDE Adverse Event Report: ONKOS SURGICAL ELEOS BOWED SEGMENTAL STEM; PROSTHESIS, HIP

Model Number	FB-15152-03M
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Bone Fracture(s) (1870)
Date of Event	04/24/2019
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The device history record and sterilization batch release record were reviewed and indicated that the component involved met specification.The segmental stem was implanted thus was unable to be further evaluated.The sales representative indicated that the appropriate instrument was not used during the surgery to prepare the bone.Should additional information be obtained the report will be supplemented.
Event or Problem Description
The patient's proximal femur fractured while implanting a canal filling bowed stem.

• Brand Name: ELEOS BOWED SEGMENTAL STEM
• Common Device Name: PROSTHESIS, HIP
• Manufacturer (Section D): ONKOS SURGICAL; 77 east halsey road; parsippany NJ 07054
• MDR Report Key: 8637464
• Report Number: 3013450937-2019-00018
• Device Sequence Number: 19429803
• Product Code: JDI
• UDI-Device Identifier: B278FB1515203M0
• UDI-Public: B278FB1515203M0
• Combination Product (Y/N): N
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: K161520
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 05/23/2019

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: 03/04/2024
• Device Model Number: FB-15152-03M
• Device Catalogue Number: FB-15152-03M
• Device Lot Number: 82295
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/24/2019
• Initial Report FDA Received Date: 05/23/2019
• 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: Required Intervention