FDA Adverse Event Injury Summary report: N

BHR

MDR report key: 2200632 · Received August 11, 2011

Report

Report Number
3005477969-2011-00174
Event Type
Injury
Date Received
August 11, 2011
Date of Event
August 9, 2011
Report Date
October 13, 2011
Manufacturer
SMITH & NEPHEW ORTHOPAEDICS, LTD.
Product Code
NXT
PMA / PMN Number
P040033
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
UK
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

SMITH & NEPHEW HAVE RECEIVED DUPLICATE REPORTS RELATED TO THIS EVENT AND INADVERTENTLY SUBMITTED TWO MDRS FOR THE SAME CASE (3005477969-2011-00173 + 3005477969-2011-00174). PLEASE TREAT THIS REPORT AS THE MASTER CASE EVALUATION AND 3005477969-2011-00173 AS AN ERRONEOUS DUPLICATE.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE ACETABULAR CUP HAD CHANGED ORIENTATION WITHIN 6 WEEKS OF IMPLANTATION. FEMORAL HEAD REMAINED IMPLANTED.

Description of Event or Problem · 1

IT WAS REPORTED THAT REVISION SURGERY WAS PERFORMED 6 WEEKS POST-IMPLANTATION DUE TO THE HORIZONTAL POSITION OF THE CUP AND REPORTED PATIENT PAIN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 BHR ACETABULAR CUP NXT SMITH & NEPHEW ORTHOPAEDICS, LTD. 11CW32011 006

Patients

Seq Age Sex Outcome Treatment
1 51 YR Hospitalization| R FEMORAL HEAD, PART# 74121150, LOT# UNKNOWN