BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR UNI FEMORAL IMPL SIZE 49

    MDR report key: 2820858 · Received November 6, 2012

    Report

    Report Number
    1818910-2012-76798
    Event Type
    Injury
    Date Received
    November 6, 2012
    Date of Event
    December 12, 2011
    Report Date
    August 14, 2012
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KWA
    PMA / PMN Number
    K040627
    Removal / Correction Number
    Z1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). 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. REF. (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. (B)(4).

    Description of Event or Problem · 1

    LITIGATION ALLEGES THAT THE PATIENT SUFFERED WEAR SYNOVITIS, MECHANICAL COMPLICATIONS LEFT TOTAL HIP REPLACEMENT, INFLAMMATORY RESPONSE TO LEFT TOTAL HIP REPLACEMENT, DAMAGES TO THE HIP STRUCTURES, SCIATIC NERVE ADHESIONS, CHROMIUM AND COBALT TOXICITY AND COMPLICATIONS THEREFROM, PHYSICAL PAIN AND DISFIGUREMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASR UNI FEMORAL IMPL SIZE 49 TOTAL HIP IMPLANT KWA DEPUY INTERNATIONAL 2759901

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Required Intervention