BEUDAMED
    FDA Adverse Event Death Summary report: N

    BIOLOX DELTA HEAD 36 MM 12/14 M / +4

    MDR report key: 14103405 · Received April 13, 2022

    Report

    Report Number
    1020279-2022-01814
    Event Type
    Death
    Date Received
    April 13, 2022
    Date of Event
    March 14, 2020
    Report Date
    June 28, 2022
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    LZO
    UDI-DI
    03596010566966
    PMA / PMN Number
    K083762
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SP
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    INTERNAL COMPLAINT REFERENCE: (B)(4). (B)(6).

    Additional Manufacturer Narrative · 0

    H10: THE DEVICE WAS NOT RETURNED FOR EVALUATION AND THE REPORTED EVENT COULD NOT BE CONFIRMED. THE CLINICAL/MEDICAL INVESTIGATION CONCLUDED THAT, IT SHOULD BE NOTED THE PATIENT HAD COMORBIDITIES THAT WERE REPORTED AS ONGOING THE YEAR PRIOR TO THEIR DEATH THAT COULD HAVE CONTRIBUTED TO THEIR DEATH. BASED ON THE INFORMATION PROVIDED THE CAUSE OF DEATH CANNOT BE CONFIRMED. WE CANNOT CONCLUDE THE S+N PRODUCTS WERE RELATED TO THE CAUSE OF DEATH. A REVIEW OF THE MANUFACTURING RECORDS DID NOT REVEAL A MANUFACTURING ABNORMALITY THAT COULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED INCIDENT. A REVIEW OF COMPLAINT HISTORY FOR THE PART NUMBER OVER THE PAST 12 MONTHS AND FOR THE BATCH NUMBER BASED ON HISTORICAL DATA OF THE DEVICE DID NOT REVEAL SIMILAR EVENTS FOR THE LISTED DEVICE. A REVIEW OF THE INSTRUCTIONS FOR USE DOCUMENTS FOR TOTAL HIP SYSTEMS PROVIDES COMPLETE GUIDELINES OF INDICATIONS, CONTRAINDICATIONS, WARNINGS AND PRECAUTIONS AND POSSIBLE ADVERSE EFFECTS THAT MAY OCCUR PREOPERATIVE, DURING SURGERY OR POST OPERATIVE. A HISTORICAL REVIEW CONCLUDED THAT THERE ARE NO PRIOR ACTIONS RELATED TO THIS PRODUCT AND EVENT. AT THIS TIME, WE HAVE NO REASON TO SUSPECT THAT THE PRODUCT FAILED TO MEET ANY PRODUCT SPECIFICATIONS AT THE TIME OF MANUFACTURE. THE PATIENT DIED 10 YEARS AFTER THE IMPLANTATION OF THE COMPLAINED DEVICE AND THE CAUSE OF DEATH IS UNKNOWN. THERE IS NO INDICATION THAT THE IMPLANT CONTRIBUTED IN ANY MANNER TO THE DEATH OF THE PATIENT. WITHOUT DETAILS OF THE ALLEGED FAULT, MALFUNCTION OR DEATH, NO PROBABLE CAUSE CAN BE DELINEATED THAT RELATES THE EVENT WITH THE DEVICE. THE CONTRIBUTION OF THE DEVICE TO THE REPORTED EVENT COULD NOT BE CORROBORATED. BASED ON THIS INVESTIGATION, THE NEED FOR CORRECTIVE ACTION IS NOT INDICATED. SHOULD THE DEVICE OR ADDITIONAL INFORMATION BE RECEIVED, THE COMPLAINT WILL BE REOPENED. NO FURTHER INVESTIGATION IS WARRANTED FOR THIS COMPLAINT; HOWEVER, WE WILL CONTINUE TO MONITOR FOR FUTURE COMPLAINTS AND INVESTIGATE AS NECESSARY. WE CONSIDER THIS INVESTIGATION CLOSED.INTERNAL COMPLAINT REFERENCE NUMBER: CASE-2022-00098571-1

    Description of Event or Problem · 0

    IT WAS REPORTED THAT AFTER A BILATERAL THR SURGERY PERFORMED (ONLY ONE IS FROM SMITH AND NEPHEW) ON (B)(6) 2010, THE CLINICAL SUBJECT PASSED AWAY ON (B)(6) 2020. THE CAUSE OF DEATH IS UNKNOWN. FURTHER INFORMATION IS NOT AVAILABLE AT THE TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2565678 BIOLOX DELTA HEAD 36 MM 12/14 M / +4 PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/CERAMIC/POLYMER, LZO SMITH & NEPHEW, INC. 76539166 09JT35811 03596010566966

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Male Death 71331752/R3 36MM ID INTL DLT CER LNR 52MM/10ET4251| 71332525/REF SPHER HEAD SCREW 25MM/10DM11868| 71332530/REF SPHER HEAD SCREW 30MM/10CM03845| 71335552/R3 3 HOLE ACET SHELL 52MM/10EM14114| 75002701/SL-PLUSSTANDARDSTEM4NON-CEMENTED/F0810096