BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR XL TAP SLV ADAP 12/14+8

    MDR report key: 2833833 · Received November 15, 2012

    Report

    Report Number
    1818910-2012-25177
    Event Type
    Injury
    Date Received
    November 15, 2012
    Date of Event
    July 10, 2012
    Report Date
    October 24, 2012
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KWA
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UK
    Reporter Occupation
    HEALTH PROFESSIONAL

    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. 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. THE CORRECTION/REMOVAL REPORTING NUMBER LISTED APPLIES TO THE CORRESPONDING PRODUCT CODE SOLD DOMESTICALLY.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT HAD A REVISION ON THE ASR HIP IMPLANT. THE REASON FOR THE REVISION IS UNEXPLAINED. IT WAS FURTHER REPORTED THAT THE PATIENT EXPERIENCED NIGHT PAIN. IT WAS FURTHER REPORTED THAT CHROMIUM AND COBALT WERE BOTH FOUND IN THE BLOOD OF THE PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASR XL TAP SLV ADAP 12/14+8 ASR TOTAL HIP REPLACEMENT KWA DEPUY INTERNATIONAL 2839239

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR Required Intervention