FDA Adverse Event Injury Summary report: N

NV GXL LINER NEUTRAL, 32MM ID GROUP 1 CUPS

MDR report key: 24603712 · Received March 16, 2026

Report

Report Number
1038671-2026-00260
Event Type
Injury
Date Received
March 16, 2026
Date of Event
February 10, 2026
Report Date
May 26, 2026
Manufacturer
EXACTECH, INC.
Product Code
JDI
UDI-DI
10885862207074
PMA / PMN Number
K121392
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
SP
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

D10: 01-032-03-3294 - UNIVERSAL CUP, HEAD, DELTA, 32MM, -4 - (B)(6). 164-01-11 - ELEMENT-STEM, COLLARLESS W/HA, STD OFFSET, SZ 11 - (B)(6). 186-01-50 - INTEGRIP CC, CLUSTER 50MM, (B)(6). THE REPORTED EVENT WAS UNABLE TO BE CONFIRMED DUE TO LIMITED INFORMATION RECEIVED FROM THE CUSTOMER. NO DEVICE WAS RETURNED FOR EVALUATION; FURTHER, PHOTOGRAPHS AND/OR RADIOGRAPH IMAGES WERE NOT PROVIDED FOR REVIEW. OPERATIVE NOTES AND/OR MEDICAL RECORDS WERE NOT PROVIDED FOR REVIEW OF USAGE/TECHNIQUE. A DEFINITIVE ROOT CAUSE WAS UNABLE TO BE DETERMINED AS THE NECESSARY INFORMATION TO ADEQUATELY INVESTIGATE THE REPORTED EVENT WAS NOT PROVIDED. IF ANY FURTHER INFORMATION IS OBTAINED THAT WOULD CHANGE OR ALTER ANY INFORMATION PROVIDED, A SUPPLEMENTAL REPORT WILL BE FILED ACCORDINGLY.

Description of Event or Problem · 0

AS REPORTED, A PATIENT UNDERWENT AN INITIAL TOTAL HIP ARTHROPLASTY, ON THE RIGHT SIDE. SUBSEQUENTLY, THE PATIENT WAS DIAGNOSED WITH PREMATURE WEAR OF THE PROSTHETIC POLYETHYLENE WITH PARTICULATE DISEASE, WAS ADMITTED TO THE HOSPITAL, AND NEEDS SURGICAL INTERVENTION TO PREVENT INJURY OR PERMANENT DISABILITY. NO FURTHER INFORMATION PROVIDED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
621531 NV GXL LINER NEUTRAL, 32MM ID GROUP 1 CUPS PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, CEMENTED JDI EXACTECH, INC. 10885862207074

Patients

Seq Age Sex Outcome Treatment
1