BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR ACETABULAR CUPS 54

    MDR report key: 2831961 · Received November 14, 2012

    Report

    Report Number
    1818910-2012-24585
    Event Type
    Injury
    Date Received
    November 14, 2012
    Date of Event
    December 8, 2014
    Report Date
    December 8, 2014
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KWA
    PMA / PMN Number
    PK040627
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Additional Manufacturer Narrative · 1

    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. (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.

    Additional Manufacturer Narrative · 1

    IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE.DEPUY STILL CONSIDERS THE INVESTIGATION CLOSED.(B)(4)

    Description of Event or Problem · 1

    LITIGATION ALLEGED THE PATIENT SUFFERED PAIN, DISCOMFORT, DECREASED MOBILITY AND ELEVATED METAL LEVELS IN HIS BLOOD AS A RESULT OF THE IMPLANTED ASR HIP.

    Description of Event or Problem · 1

    NEW ETQ RECORD CREATED IN ORDER TO UPDATE ETQ (LEGACY SYSTEM) COMPLAINT NUMBER WPC (B)(4). REASON FOR ORIGINAL COMPLAINT - LITIGATION ALLEGED THE PATIENT SUFFERED PAIN, DISCOMFORT, DECREASED MOBILITY AND ELEVATED METAL LEVELS IN HIS BLOOD AS A RESULT OF THE IMPLANTED ASR HIP. UPDATE REC'D 12/8/2014- SALES REP REPORTED REVISION SURGERY. PATIENT REVISED TO REMOVE METAL ON METAL IMPLANT. NO OTHER REASON FOR REVISION GIVEN. THE STEM AND SLEEVE HAVE BEEN ADDED TO THE COMPLAINT FOR ELEVATED METAL ION LEVELS. THIS COMPLAINT WAS UPDATED ON 1/5/2014.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASR ACETABULAR CUPS 54 HIP ACETABULAR CUP KWA DEPUY INTERNATIONAL 2513422

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Other| R