BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR UNI FEMORAL IMPL SIZE 45

    MDR report key: 2122692 · Received June 3, 2011

    Report

    Report Number
    1818910-2011-09789
    Event Type
    Injury
    Date Received
    June 3, 2011
    Report Date
    May 4, 2011
    Manufacturer
    DEPUY INTERNATIONAL, LTD.
    Product Code
    KXA
    PMA / PMN Number
    K040627
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    ATTORNEY

    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

    DEPUY STILL CONSIDERS THE INVESTIGATION CLOSED.

    Additional Manufacturer Narrative · 1

    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: ON OR ABOUT (B)(6) 2009, PT WAS IMPLANTED WITH A DEPUY ASR XL HIP ON HER RIGHT SIDE. SINCE THE SURGICAL IMPLANTATION, PT HAS EXPERIENCED SYMPTOMS INCLUDING BUT NOT LIMITED TO GROIN PAIN, HIP PAIN, ELEVATED LEVELS OF METAL IONS AND PROBLEMS SITTING, STANDING AND MOVING UP AND DOWN STAIRS. ADDITIONALLY, IT IS ALLEGED THAT PT NOW FACES THE POTENTIAL FOR A REVISION SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASR UNI FEMORAL IMPL SIZE 45 KWA KXA DEPUY INTERNATIONAL, LTD. NA 2929033

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Required Intervention