BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEPUY ASR FEM IMPLANT SZ 47

    MDR report key: 2930942 · Received January 28, 2013

    Report

    Report Number
    1818910-2013-01614
    Event Type
    Injury
    Date Received
    January 28, 2013
    Report Date
    August 22, 2012
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KXA
    PMA / PMN Number
    K032659
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, 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. 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. (B)(4).

    Description of Event or Problem · 1

    LITIGATION PAPERS ALLEGE, THE PATIENT SUFFERS FROM LOWER BACK PAIN THAT RADIATES DOWN HIS LEGS. THE PATIENT IS CONCERNED ABOUT THE POSSIBILITY OF A REVISION SURGERY AND THE FUTURE HEALTH EFFECTS OF ELEVATED METAL IONS IN HIS BLOOD, WHICH IS BEING MONITORED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    37048 DEPUY ASR FEM IMPLANT SZ 47 FEMORAL HEAD HIP IMPLANT KXA DEPUY INTERNATIONAL 1099409

    Patients

    Seq Age Sex Outcome Treatment
    1 Other