FDA Adverse Event Injury Summary report: N

ASR ACETABULAR CUPS 50

MDR report key: 1873750 · Received September 27, 2010

Report

Report Number
1818910-2010-06684
Event Type
Injury
Date Received
September 27, 2010
Report Date
September 1, 2010
Manufacturer
DEPUY INTERNATIONAL, LTD.
Product Code
KWA
PMA / PMN Number
K040627
Removal / Correction Number
Z-1749/1816-2011
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
IL, US
Reporter Occupation
UNKNOWN

Narratives

Additional Manufacturer Narrative · 1

THE ASR PLATFORM WAS VOLUNTARILY RECALLED FROM THE MARKET IN AUGUST 2010, AND THE ASR PRODUCT CODES ARE NOW CONSIDERED INACTIVE. FURTHER INVESTIGATION OF THIS INDIVIDUAL INCIDENT WILL NOT BE UNDERTAKEN, AS THERE IS AN ONGOING INVESTIGATION REGARDING THE ROOT CAUSE(S) AND/OR CORRECTIVE ACTIONS. REF. (B)(4).

Additional Manufacturer Narrative · 1

DEPUY STILL CONSIDERS THE INVESTIGATION CLOSED AT THIS TIME. SHOULD THE PRODUCT AND/OR ADDITIONAL INFORMATION BE RECEIVED, THE INVESTIGATION WILL BE RE-OPENED.

Additional Manufacturer Narrative · 1

THE DEVICES ASSOCIATED WITH THIS REPORT WERE NOT RETURNED. A COMPLAINT DATABASE SEARCH WAS NOT POSSIBLE AS THE REQUIRED PRODUCT AND LOT CODE INFO WAS NOT PROVIDED. REVIEW OF THE DEVICE HISTORY RECORDS WAS ALSO NOT POSSIBLE DUE TO INSUFFICIENT INFO. THE INVESTIGATION COULD NOT DRAW ANY CONCLUSIONS REGARDING THE REPORTED EVENT. BASED ON THE INABILITY TO DETERMINE A ROOT CAUSE, THE NEED FOR CORRECTIVE ACTION IS NOT INDICATED. DEPUY CONSIDERS THE INVESTIGATION CLOSED AT THIS TIME. SHOULD THE PRODUCT AND/OR ADDITIONAL INFORMATION BE RECEIVED, THE INVESTIGATION WILL BE RE-OPENED.

Description of Event or Problem · 1

LEGAL CLAIM FORWARDED TO CUSTOMER QUALITY FOR REVIEW. NO OTHER INFO IS AVAILABLE AT THIS TIME.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ASR ACETABULAR CUPS 50 ACETABULAR CUP HIP IMPLANT KWA DEPUY INTERNATIONAL, LTD. NA 2300349

Patients

Seq Age Sex Outcome Treatment
1 NA Required Intervention