BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR ACETABULAR IMPLANT 50

    MDR report key: 2863393 · Received December 10, 2012

    Report

    Report Number
    1818910-2012-25566
    Event Type
    Injury
    Date Received
    December 10, 2012
    Date of Event
    November 26, 2012
    Report Date
    December 9, 2012
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KWA
    Removal / Correction Number
    Z- 1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MY
    Reporter Occupation
    PATIENT

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

    Additional Manufacturer Narrative · 1

    THIS PRODUCT HAS NOT BEEN REVISED AS ORIGINALLY REPORTED. THIS PRODUCT IS STILL IMPLANTED AND HAS NOT BEEN REMOVED. THIS REPORT IS CONSIDERED CLOSED AT THIS TIME.

    Description of Event or Problem · 1

    RIGHT HIP.

    Description of Event or Problem · 1

    ASR REVISION; ASR XL - LEFT; REASON(S) FOR REVISION: PAIN AND LOOSENING OF THE LEFT STEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASR ACETABULAR IMPLANT 50 ASR TOTAL HIP REPLACEMENT KWA DEPUY INTERNATIONAL 2513415

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention