BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR UNI FEMORAL UMPL SIZE 43

    MDR report key: 2093842 · Received May 12, 2011

    Report

    Report Number
    1818910-2011-08183
    Event Type
    Injury
    Date Received
    May 12, 2011
    Date of Event
    March 28, 2011
    Report Date
    April 12, 2011
    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
    TN, US
    Reporter Occupation
    OTHER

    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. (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.

    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.

    Description of Event or Problem · 1

    PATIENT WAS REVISED TO ADDRESS GROIN AND THIGH PAIN. IT WAS FOUND INTRAOPERATIVELY THE CUP WAS IN EXTREME ANTEVERSION AND VERTICAL INCLINATION. THE S-ROM SLEEVE WAS FOUND TO BE LOOSE AND SUBSIDED. REVISION OPERATIVE REPORT RECEIVED. IT WAS NOTED THAT THE PATIENT HAD ELEVATED METAL ION LEVELS. ADDITIONALLY A LARGE AMOUNT OF CLOUDY YELLOW JOINT FLUID WAS EVACUATED UPON OPENING THE JOINT CAPSULE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASR UNI FEMORAL UMPL SIZE 43 87KWA KWA DEPUY INTERNATIONAL, LTD. NA 2929030

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Required Intervention