BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR ACETABULAR CUPS 50

    MDR report key: 2233076 · Received September 2, 2011

    Report

    Report Number
    1818910-2011-17138
    Event Type
    Injury
    Date Received
    September 2, 2011
    Report Date
    August 5, 2011
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KWA
    PMA / PMN Number
    K040627
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    ATTORNEY

    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

    DEPUY STILL CONSIDERS THIS INVESTIGATION CLOSED.

    Description of Event or Problem · 1

    LITIGATION PAPERS ALLEGE THE FOLLOWING: ON OR ABOUT (B)(6) 2010, PATIENT BEGAN SUFFERING DISCOMFORT, PAIN, AND ACHING. HER HIP PAIN CONTINUED TO WORSEN CONSIDERABLY AND SIGNIFICANTLY IMPAIR HER ABILITY TO DRIVE, WORK AND EVEN STAND. IT IS ALSO ALLEGED PATIENT HAS INCREASED METAL IONS LEVELS. UPDATE: 11/14/2011 - THE SALES REP HAS REPORTED THE REVISION SURGERY. PATIENT WAS REVISED DUE TO PAIN.

    Description of Event or Problem · 1

    LITIGATION PAPERS ALLEGE THE FOLLOWING: ON OR ABOUT (B)(6) 2010, PATIENT BEGAN SUFFRERING DISCOMFORT, PAIN, AND ACHING. HER HIP PAIN CONTINUED TO WORSEN CONSIDERABLY AND SIGNIFICANTLY IMPAIR HER ABILITY TO DRIVE, WORK AND EVEN STAND. IT IS ALSO ALLEGED PATIENT HAS INCREASED METAL IONS LEVELS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASR ACETABULAR CUPS 50 ACETABULAR CUP KWA DEPUY INTERNATIONAL 2296029

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention