FDA Adverse Event
Injury
Summary report: N
DEPUY ASR XL FEM IMP SIZE 49
MDR report key: 2901428
·
Received January 8, 2013
Report
- Report Number
- 1818910-2013-00129
- Event Type
- Injury
- Date Received
- January 8, 2013
- Date of Event
- May 16, 2011
- Report Date
- September 3, 2013
- Manufacturer
- DEPUY INTERNATIONAL
- Product Code
- KWA
- Removal / Correction Number
- Z-1749/1816-2011
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- US
- Reporter Occupation
- ATTORNEY
Narratives
Additional Manufacturer Narrative · 1
DEPUY STILL CONSIDERS THE INVESTIGATION CLOSED.
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
REASON FOR REVISION: COMPONENT MALALIGNMENT, PAIN.
Description of Event or Problem · 1
ASR REVISION; ASR XL ACETABULAR SYSTEM; REASON FOR REVISION - UNKNOWN.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 9205 | DEPUY ASR XL FEM IMP SIZE 49 | ASR TOTAL HIP REPLACEMENT | KWA | DEPUY INTERNATIONAL | 1936224 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Required Intervention |