MAUDE Adverse Event Report: SMITH & NEPHEW, INC. GEN II RESURF PATELLA 41MM; PROSTH, KNEE, PATELLOFEMOROTIBIAL, SEMI-CONST, CEMENTED, POLY/METAL/POLY

Catalog Number	71926226
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Injury (2348)
Date of Event	02/01/2019
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported right knee effusion post operative.The event was resolved performing an unspecified surgical procedure.
Event or Problem Description
It was reported that the patient presented the following symptoms post operatively: right popliteal tendonitis; right posterolateral knee soft tissue impingement.It was resolved with unspecified surgical procedure.
Additional Manufacturer Narrative
The associated complaint devices were not returned.The clinical/medical team concluded, no clinical information has been provided to perform a thorough medical investigation.Should any additional medical information be provided this complaint will be re-assessed.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 prior complaints for the listed batches/failure mode.Without the actual device involved our investigation cannot proceed.If the device or new information is received in the future, the complaints can be re-opened.No further actions are being taken at this time.

• Brand Name: GEN II RESURF PATELLA 41MM
• Common Device Name: PROSTH, KNEE, PATELLOFEMOROTIBIAL, SEMI-CONST, CEMENTED, POLY/METAL/POLY
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• MDR Report Key: 8897952
• Report Number: 1020279-2019-03062
• Device Sequence Number: 19182483
• Product Code: JWH
• UDI-Device Identifier: 03596010587596
• UDI-Public: 03596010587596
• Combination Product (Y/N): N
• PMA/510(K) Number: K951987
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 11/08/2019

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: 09/23/2024
• Device Catalogue Number: 71926226
• Device Lot Number: 14JM19091
• Initial Date Received by Manufacturer: 07/16/2019
• Supplement Date Received by Manufacturer: 07/16/2019; 07/16/2019
• Initial Report FDA Received Date: 08/15/2019
• Supplement Report FDA Received Date: 08/20/2019; 11/08/2019
• 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: Hospitalization; Required Intervention