BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN_RECONSTRUCTIVE_PRODUCT

    MDR report key: 2935935 · Received January 30, 2013

    Report

    Report Number
    0002249697-2013-00481
    Event Type
    Injury
    Date Received
    January 30, 2013
    Date of Event
    January 9, 2013
    Report Date
    January 9, 2013
    Manufacturer
    STRYKER ORTHOPAEDICS-MAHWAH
    Product Code
    UNK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    AN EVENT REGARDING REVISION INVOLVING AN UNKNOWN REJUVENATE MODULAR DEVICE WAS REPORTED. THE EVENT WAS CONFIRMED. DEVICE EVALUATION WAS NOT PERFORMED AS NO DEVICES WERE RECEIVED. A REVIEW OF DEVICE HISTORY RECORDS COULD NOT BE PERFORMED AS THE REPORTED DEVICE WAS NOT PROPERLY IDENTIFIED. SIMILAR EVENTS HAVE OCCURRED FOR THE REJUVENATE MODULAR PRODUCT FAMILY. THESE EVENTS WERE DETERMINED TO BE ASSOCIATED WITH RA 2012-067. NO FURTHER INVESTIGATION IS REQUIRED.

    Additional Manufacturer Narrative · 1

    CATALOGUE NUMBER UNKNOWN AT THIS TIME. DEVICE DESCRIPTION REPORTED AS UNKNOWN REJUVENATE MODULAR FEMORAL STEM. AN EVALUATION OF THE DEVICE CANNOT BE PERFORMED AS THE DEVICE WAS NOT RETURNED TO THE MANUFACTURER. ADDITIONAL INFORMATION PERTAINING TO THE DEVICE REFERENCED IN THIS REPORT (INCLUDING X-RAYS AND MEDICAL RECORDS) HAS BEEN REQUESTED. SHOULD ADDITIONAL INFORMATION BECOME AVAILABLE, THE EVALUATION SUMMARY WILL BE SUBMITTED IN A SUPPLEMENTAL REPORT. DEVICE NOT RETURNED TO THE MANUFACTURER.

    Description of Event or Problem · 1

    THE PATIENT UNDERWENT REVISION SURGERY FOLLOWING A DIAGNOSIS OF ALTR. THE FOLLOWING WERE MEASURED AT 15 MONTHS POST INDEX SURGERY: COBALT - 11; CHROMIUM 3.2. THE PATIENT WAS REPORTED TO BE SYMPTOMATIC: TROCHANTERIC/GROIN JUST LAST COUPLE MONTHS. INFECTION WAS NOT DIAGNOSED.

    Description of Event or Problem · 1

    THE PATIENT UNDERWENT REVISION SURGERY FOLLOWING A DIAGNOSIS OF ALTR. THE FOLLOWING WERE MEASURED AT 15 MONTHS POST INDEX SURGERY: COBALT - 11; CHROMIUM 3.2. THE PATIENT WAS REPORTED TO BE SYMPTOMATIC: TROCHANTERIC/GROIN JUST LAST COUPLE MONTHS. INFECTION WAS NOT DIAGNOSED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    41552 UNKNOWN_RECONSTRUCTIVE_PRODUCT IMPLANT UNK STRYKER ORTHOPAEDICS-MAHWAH

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention