BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PFC SIG CRUC SUB SZ3 W/LUGS RT

    MDR report key: 2772126 · Received October 4, 2012

    Report

    Report Number
    1818910-2012-22591
    Event Type
    Injury
    Date Received
    October 4, 2012
    Report Date
    September 18, 2012
    Manufacturer
    DEPUY RAYNHAM
    Product Code
    JWH
    PMA / PMN Number
    K943462
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, US
    Reporter Occupation
    PHYSICIAN

    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

    THE DEVICE ASSOCIATED WITH THIS REPORT EVENT REMAINS IMPLANTED. NO REVISION HAS BEEN REPORTED. A COMPLAINT DATABASE SEARCH FINDS NO OTHER REPORTED INCIDENTS AGAINST THE PROVIDED PRODUCT AND LOT COMBINATION SINCE ITS RELEASE FOR DISTRIBUTION. THE INVESTIGATION COULD NOT DRAW ANY CONCLUSIONS REGARDING THE REPORTED EVENT BASED ON THE PROVIDED INFORMATION. BASED ON THE INABILITY TO DETERMINE A ROOT CAUSE, THE NEED FOR CORRECTIVE ACTION WAS NOT INDICATED. DEPUY CONSIDERS THE INVESTIGATION CLOSED AT THIS TIME. SHOULD ADDITIONAL INFORMATION BE RECEIVED, THE INVESTIGATION WILL BE RE-OPENED.

    Description of Event or Problem · 1

    CLINICAL REPORT STATES: RIGHT KNEE PERIPATELLAR CREPITUS STATUS POST TKA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PFC SIG CRUC SUB SZ3 W/LUGS RT FEMORAL IMPLANT (KNEE) JWH DEPUY RAYNHAM BA4AG4000

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention