BEUDAMED
    FDA Adverse Event Injury Summary report: N

    M2A MODULAR HEAD COMPONENT 38MM HEAD DIAMETER PLUS 3MM NECK

    MDR report key: 2800794 · Received October 23, 2012

    Report

    Report Number
    0001825034-2012-02094
    Event Type
    Injury
    Date Received
    October 23, 2012
    Date of Event
    July 20, 2006
    Report Date
    September 28, 2012
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    KWA
    PMA / PMN Number
    PK011110
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE USER FACILITY IS OUTSIDE OF THE UNITED STATES. NO MEDWATCH REPORT WAS RECEIVED. CURRENT INFORMATION IS INSUFFICIENT TO PERMIT A CONCLUSION AS TO THE CAUSE OF THE EVENT. REVIEW OF DEVICE HISTORY RECORDS SHOW THAT LOT RELEASED WITH NO RECORDED ANOMALY. THIS REPORT IS NUMBER 3 OF 3 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2012-02092 / 02094).

    Description of Event or Problem · 1

    IT WAS REPORTED PATIENT UNDERWENT TOTAL HIP ARTHROPLASTY ON (B)(6) 2005. SUBSEQUENTLY, A REVISION PROCEDURE WAS PERFORMED ON (B)(6) 2006 DUE TO UNKNOWN REASONS. THE HEAD WAS REMOVED AND REPLACED WITH ANOTHER BIOMET HEAD. A FURTHER REVISION PROCEDURE WAS PERFORMED ON (B)(6) 2012 ALLEGEDLY DUE TO PAIN AND INSTABILITY. THE ACETABULAR CUP AND FEMORAL HEAD WERE REMOVED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 M2A MODULAR HEAD COMPONENT 38MM HEAD DIAMETER PLUS 3MM NECK PROSTHESIS, HIP KWA BIOMET ORTHOPEDICS N/A 583670

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R