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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: SMITH & NEPHEW, INC. LEGION HK TIBIAL BASE SZ 5 LT; PROSTHESIS, KNEE, FEMOROTIBIAL, CONSTRAINED, CEMENTED, METAL/POLYMER
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SMITH & NEPHEW, INC. LEGION HK TIBIAL BASE SZ 5 LT; PROSTHESIS, KNEE, FEMOROTIBIAL, CONSTRAINED, CEMENTED, METAL/POLYMER Back to Search Results
Catalog Number 71421305
Medical Device Problem Code Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes Rupture (2208); Injury (2348)
Date of Event 06/20/2018
Type of Reportable Event Serious Injury
Event or Problem Description
It was reported that the patient had rupture of left quad tendon postoperative.An unspecified surgery was performed to remediate it.
 
Additional Manufacturer Narrative
The associated complaint devices were not returned.A clinical evaluation was conducted and without the requested clinical information a thorough medical investigation cannot be rendered.Should any additional medical information be provided this complaint will be re-assessed.Without the actual product involved and/or device information, our investigation cannot proceed.If the device or new information is received in the future, this complaint can be re-opened.No further actions are being taken at this time.
 
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Brand Name
LEGION HK TIBIAL BASE SZ 5 LT
Common Device Name
PROSTHESIS, KNEE, FEMOROTIBIAL, CONSTRAINED, CEMENTED, METAL/POLYMER
Manufacturer (Section D)
SMITH & NEPHEW, INC.
1450 brooks road
memphis TN 38116
MDR Report Key9451205
Report Number1020279-2019-04380
Device Sequence Number3039881
Product Code KRO
UDI-Device Identifier00885556109137
UDI-Public00885556109137
Combination Product (Y/N)N
Initial Reporter StateOR
PMA/510(K) Number
K081111
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source company representative,study
Initial Reporter Occupation Other
Type of Report Initial,Followup
Report Date (Section B) 12/11/2019
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 Catalogue Number71421305
Was Device Available for Evaluation? No
Initial Date Received by Manufacturer 11/14/2019
Supplement Date Received by Manufacturer11/14/2019
Initial Report FDA Received Date12/11/2019
Supplement Report FDA Received Date12/11/2019
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)		 No
Patient Sequence Number1
Outcome Attributed to Adverse Event Life Threatening; Required Intervention;
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