FDA Adverse Event Injury Summary report: N

FEM. MODULAR HEAD - M Ø28MM 2

MDR report key: 15649331 · Received October 21, 2022

Report

Report Number
3008021110-2022-00095
Event Type
Injury
Date Received
October 21, 2022
Date of Event
September 19, 2022
Report Date
October 6, 2022
Manufacturer
LIMACORPORATE S.P.A.
Product Code
LPH
PMA / PMN Number
K112158
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

THE STERILIZATION CHARTS OF THE INVOLVED DEVICES WERE CHECKED WITH THE FOLLOWING RESULTS: NO PRE-EXISTING ANOMALY ON THE 48 FEM. MODULAR HEAD - M Ø28MM THAT BELONG TO PRODUCT CODE 5010.09.282, LOT NUMBER 2208982, STERILIZATION NUMBER 2200141. NO PRE-EXISTING ANOMALY ON THE 24 LOCK BIPOL.SELF-CENT.HEAD Ø48 THAT BELONG TO PRODUCT CODE 5527.05.480, LOT NUMBER 2203180, STERILIZATION NUMBER 2200065. THEREFORE, WE CAN STATE THAT THE INVOLVED COMPONENTS WERE REGULARLY STERILIZED BEFORE BEING PLACED ON THE MARKET. WE WILL SUBMIT A FINAL REPORT AFTER THE CONCLUSION OF THE INVESTIGATION.

Additional Manufacturer Narrative · 0

THE STERILIZATION CHARTS OF THE INVOLVED DEVICES WERE CHECKED WITH THE FOLLOWING RESULTS: - NO PRE-EXISTING ANOMALY ON THE 48 FEM. MODULAR HEAD - M Ø28MM THAT BELONG TO PRODUCT CODE 5010.09.282, LOT NUMBER 2208982, STERILIZATION NUMBER (B)(4) - NO PRE-EXISTING ANOMALY ON THE 24 LOCK BIPOL.SELF-CENT.HEAD Ø48 THAT BELONG TO PRODUCT CODE 5527.05.480, LOT NUMBER 2203180, STERILIZATION NUMBER (B)(4) THEREFORE, WE CAN STATE THAT THE INVOLVED COMPONENTS WERE REGULARLY STERILIZED BEFORE BEING PLACED ON THE MARKET. NO OTHER COMPLAINTS DUE TO INFECTION IS REGISTERED IN OUR SYSTEM CONCERNING STER. NUMBERS (B)(4). VERY FEW INFORMATION IS AVAILABLE ON THIS CASE, SPECIFICALLY, THE FOLLOWING DETAILS WERE REQUESTED TO THE COMPLAINT SOURCE BUT NEVER SHARED WITH LIMACORPORATE: - X-RAYS - GERM RESPONSIBLE FOR THE INFECTION REPORTED WITHOUT THE POSSIBILITY TO ANALYZE ADDITIONAL INFORMATION, NO DEEP ANALYSIS CAN BE PERFORMED, THEREFORE WE CANNOT DETERMINE THE CAUSE OF THE INFECTION. NEVERTHELESS, THE CHECK OF THE STERILIZATION CHARTS CONFIRMED THAT THE DEVICES INVOLVED WERE REGULARLY STERILIZED, NO ANOMALY DETECTED. IN CONCLUSION, IT SEEMS THAT THE INFECTION WAS CAUSED BY EXTERNAL FACTORS NOT RELATED TO THE PRODUCTS. PMS DATA BASED ON LIMACORPORATE'S PMS DATA, WE ESTIMATE A REVISION RATE OF THE FEMORAL HEADS BELONGING TO FAMILY CODES 5010.09.XXX DUE TO INFECTION OF ABOUT (B)(4). NO CORRECTIVE ACTION NEEDED FOLLOWING THIS COMPLAINT. LIMACORPORATE WILL CONTINUE TO MONITOR THE MARKET TO PROMPTLY DETECT ANY FURTHER SIMILAR EVENT.

Description of Event or Problem · 0

REVISION SURGERY PERFORMED ON (B)(6) 2022, DUE TO INFECTION. THE FOLLOWING IS THE LIST OF THE COMPONENTS INVOLVED: FEM. MODULAR HEAD - M Ø28MM (PRODUCT CODE 5010.09.282, LOT NUMBER 2208982, STERILIZATION NUMBER 2200141). LOCK BIPOL.SELF-CENT.HEAD Ø48 (PRODUCT CODE 5527.05.480, LOT NUMBER 2203180, STERILIZATION NUMBER 2200065, PRODUCT NOT SOLD IN US). THE PREVIOUS SURGERY TOOK PLACE ON (B)(6) 2022. THE EVENT OCCURRED IN ITALY.

Description of Event or Problem · 0

REVISION SURGERY PERFORMED ON (B)(6) 2022, DUE TO INFECTION. THE FOLLOWING IS THE LIST OF THE COMPONENTS INVOLVED: FEM. MODULAR HEAD - M Ø28MM (PRODUCT CODE 5010.09.282, LOT NUMBER 2208982, STERILIZATION NUMBER (B)(4)) LOCK BIPOL.SELF-CENT.HEAD Ø48 (PRODUCT CODE 5527.05.480, LOT NUMBER 2203180, STERILIZATION NUMBER (B)(4)). THE PREVIOUS SURGERY TOOK PLACE ON (B)(6) 2022. THE PATIENT IS 81 YEARS OLD. PAST MEDICAL HISTORY: NEUROSIS, GASTRO/ESOPHAGEAL REFLUX DISEASE. APPENDECTOMY, CESAREAN SECTION, OVARIAN CYST OPERATION. THIS EVENT OCCURRED IN ITALY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2558889 FEM. MODULAR HEAD - M Ø28MM 2 MODULAR FEMORAL HEADS (COCRMO) DIA. 28MM M TAPER 12/14 LPH LIMACORPORATE S.P.A. 5010.09.282 2208982

Patients

Seq Age Sex Outcome Treatment
1 Unknown Required Intervention