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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ADVANCED BIONICS, LLC HIRES ULTRA 3D IMPLANT COCHLEAR IMPLANT

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ADVANCED BIONICS, LLC HIRES ULTRA 3D IMPLANT COCHLEAR IMPLANT Back to Search Results
Model Number CI-1601-05
Device Problems Defective Component (2292); Difficult to Open or Remove Packaging Material (2922); Therapeutic or Diagnostic Output Failure (3023)
Patient Problem Failure of Implant (1924)
Event Date 05/11/2020
Event Type  Injury  
Event Description

The recipient is reportedly experiencing a partial electrode insertion. Programming adjustments were made, however, the issue did not resolve. Revision surgery is scheduled.

 
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Brand NameHIRES ULTRA 3D IMPLANT
Type of DeviceCOCHLEAR IMPLANT
Manufacturer (Section D)
ADVANCED BIONICS, LLC
28515 westinghouse place
valencia CA 91355
Manufacturer Contact
brooke lopez
28515 westinghouse place
valencia, CA 91355
MDR Report Key9911871
MDR Text Key186735473
Report Number3006556115-2020-00181
Device Sequence Number1
Product Code MCM
Combination Product (Y/N)N
Reporter Country CodeUS
PMA/PMN NumberP960058
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type HEALTH PROFESSIONAL
Reporter Occupation OTHER HEALTH CARE PROFESSIONAL
Type of Report Initial,Followup,Followup
Report Date 03/10/2020
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received04/01/2020
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? No
Device Operator LAY USER/PATIENT
Device MODEL NumberCI-1601-05
Was Device Available For Evaluation? Device Returned To Manufacturer
Date Returned to Manufacturer05/22/2020
Is The Reporter A Health Professional? Yes
Was the Report Sent to FDA?
Event Location No Information
Was Device Evaluated By Manufacturer? Yes
Date Device Manufactured07/27/2019
Is The Device Single Use? Yes
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient TREATMENT DATA
Date Received: 04/01/2020 Patient Sequence Number: 1
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