BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AMISTEM H FEMORAL STEM

    MDR report key: 2894237 · Received December 21, 2012

    Report

    Report Number
    3005180920-2012-00097
    Event Type
    Injury
    Date Received
    December 21, 2012
    Date of Event
    November 30, 2012
    Report Date
    December 21, 2012
    Manufacturer
    MEDACTA INTERNATIONAL SA
    Product Code
    LZO
    PMA / PMN Number
    K093944
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    DOCUMENT REVIEW: AMISTEM H FEMORAL STEM SIZE 5 LAT - REF. (B)(4) / LOT 112388 (49 STEMS PRODUCED). ALL PARAMETERS WERE FOUND TO BE IN ACCORDANCE WITH THE SPECIFICATIONS VALID AT THE TIME OF MANUFACTURING, INCLUDED WASHING AND STERILIZATION CYCLES. TWENTY-NINE STEMS BELONGING TO THIS LOT HAVE BEEN ALREADY IMPLANTED AND NO INCIDENTS HAVE BEEN REPORTED UP TO NOW. FROM THE DATA COLLECTED, THE CAUSE OF THE LOOSENING IS UNKNOWN AND WE DO NOT HAVE EVIDENCES THAT THE EVENT IS DETAIL RELATED; THIS IS A KNOWN COMPLICATION OF THR.

    Description of Event or Problem · 1

    REVISION SURGERY DUE TO LOOSENING OF THE STEM 10 MONTHS POST OP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AMISTEM H FEMORAL STEM FEMORAL STEM SIZE 5 LAT CEMENTLESS LZO MEDACTA INTERNATIONAL SA 112388

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Required Intervention