BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN SROM

    MDR report key: 2071496 · Received April 15, 2011

    Report

    Report Number
    1818910-2011-06664
    Event Type
    Injury
    Date Received
    April 15, 2011
    Date of Event
    June 18, 2008
    Report Date
    October 22, 2012
    Manufacturer
    DEPUY INTERNATIONAL, LTD.
    Product Code
    KWA
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS COMPLAINT IS STILL UNDER INVESTIGATION. DEPUY WILL NOTIFY THE FDA OF THE RESULTS OF THIS INVESTIGATION ONCE IT HAS BEEN COMPLETED.

    Additional Manufacturer Narrative · 1

    THIS PRODUCT HAS NOT BEEN REVISED.

    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. (B)(4). 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

    LITIGATION PAPERS ALLEGE: SOMETIME AFTER IMPLANT SURGERY, PATIENT BEGAN EXPERIENCING SYMPTOMS INCLUDING BUT NOT LIMITED TO, HARSH PAIN, DISCOMFORT AND SORENESS, WHICH IN TURN NEGATIVELY AFFECTED PATIENT'S ABILITY TO WALK, MOVE, AND SLEEP. HE HAS BEEN UNABLE TO WORK SINCE HIS INITIAL HIP IMPLANT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN SROM NONE KWA DEPUY INTERNATIONAL, LTD. 523420 UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Required Intervention