Brand Name | SIMPLEX HV GENTA |
Type of Device | SIMPLEX HV |
Manufacturer (Section D) |
OSARTIS GMBH |
lagerstrasse 11-15 |
dieburg, 64807 |
GM 64807 |
|
Manufacturer (Section G) |
OSARTIS GMBH |
lagerstrasse 11-15 |
|
dieburg, 64807 |
GM
64807
|
|
Manufacturer Contact |
volker
stirnal
|
lagerstrasse 11-15 |
dieburg, 64807
|
GM
64807
|
|
MDR Report Key | 8902575 |
MDR Text Key | 154624307 |
Report Number | 9615014-2019-00003 |
Device Sequence Number | 1 |
Product Code |
MBB
|
UDI-Device Identifier | 04260056885761 |
UDI-Public | 04260056885761 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K123081 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer,distributor,foreign |
Reporter Occupation |
Physician
|
Remedial Action |
Notification |
Type of Report
| Initial |
Report Date |
08/15/2019 |
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
|
Device Operator |
No Information
|
Device Expiration Date | 09/30/2020 |
Device Model Number | 6195-1-001 |
Device Catalogue Number | 6195-1-010 |
Device Lot Number | 836BA920EZ |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
07/18/2019 |
Initial Date FDA Received | 08/16/2019 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 07/14/2017 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Treatment | NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11MM; TRI TS BASEPLATE SIZE 7; TRIATHLON ASYMMETRIC X3 PATELLA; TRIATHLON PS FEM COMP #8L-CEM, LIM |
Patient Outcome(s) |
Other;
|
Patient Age | 76 YR |
Patient Weight | 122 |
|
|