FDA Adverse Event Injury Summary report: N

MECTACER BIOLOX DELTA FEMORAL BALL HEAD

MDR report key: 22792530 · Received August 13, 2025

Report

Report Number
3005180920-2025-00791
Event Type
Injury
Date Received
August 13, 2025
Date of Event
July 30, 2025
Report Date
August 13, 2025
Manufacturer
MEDACTA INTERNATIONAL SA
Product Code
LZO
UDI-DI
07630030809163
PMA / PMN Number
K112115
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
003

Narratives

Additional Manufacturer Narrative · 0

BATCH REVIEW PERFORMED ON 04 AUG 2025 BALL HEADS: MECTACER 01.29.205 MECTACER HEAD BIOLOX DELTA DIA.32 12/14-M (K112115) LOT 2114364: 150 ITEMS MANUFACTURED AND RELEASED ON 10-JAN-2022. EXPIRATION DATE: 2026-12-22. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. ADDITIONAL COMPONENT INVOLVED AND REVISED: BATCH REVIEW PERFORMED ON 04 AUG 2025 CUP: VERSAFITCUP 01.32.148DH ACETABULAR SHELL Ø48 TWO-HOLES (K230011) LOT 2115585: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 24-JAN-2022. EXPIRATION DATE: 2027-01-10. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. BASED ON THE INFORMATION AVAILABLE NO DEFINITIVE ROOT CAUSE CAN BE ESTABLISHED, WHILE THERE IS NO INDICATION THAT ANY POTENTIAL ISSUE WITH THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT, AND THE DEVICE HISTORY RECORD REVIEW DOES NOT INDICATE ANY POTENTIAL MANUFACTURING RELATED ISSUE.

Description of Event or Problem · 0

AT 3 YEARS 2 MONTHS FROM PRIMARY, THE PATIENT CAME IN DUE TO INSTABILITY WITH UNKNOWN CAUSE. THE SURGEON UPSIZED THE HEAD. ADDITIONALLY, THE SURGEON BELIEVED THE CUP WAS LOOSE, SO HE REVISED THE CUP AND LINER WITH COMPETITOR DEVICES. THE SURGERY WAS COMPLETED SUCCESSFULLY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
66079 MECTACER BIOLOX DELTA FEMORAL BALL HEAD FEMORAL HEAD Ø 32 SIZE M LZO MEDACTA INTERNATIONAL SA 01.29.205 2114364 07630030809163

Patients

Seq Age Sex Outcome Treatment
1 NA Female Required Intervention