BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PINNACLE SECTOR II CUP 56MM

    MDR report key: 2945105 · Received February 6, 2013

    Report

    Report Number
    1818910-2013-11935
    Event Type
    Injury
    Date Received
    February 6, 2013
    Date of Event
    July 22, 2010
    Report Date
    January 10, 2013
    Manufacturer
    DEPUY SYNTHES
    Product Code
    KWA
    PMA / PMN Number
    PK073504
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    ATTORNEY

    Narratives

    Additional Manufacturer Narrative · 1

    EXAMINATION OF REPORTED DEVICES WAS NOT POSSIBLE AS THEY WERE NOT RETURNED. REASON FOR REVISION WAS NOT PROVIDED. FURTHER INFORMATION REGARDING THIS REPORT WAS NOT MADE AVAILABLE TO CUSTOMER QUALITY. THE INITIAL REPORTING INDICATES DEPUY'S INABILITY TO OBTAIN THE PATIENT'S MEDICAL RECORDS AND X-RAYS OR DETAILS REGARDING THE AVAILABILITY OF THE EXPLANTED PRODUCT(S) RELATING TO BOTH THE ORIGINAL IMPLANT AND REVISION PROCEDURES. THE INVESTIGATION CAN DRAW NO CONCLUSION WITH THE INFORMATION PROVIDED. BASED ON THE INABILITY TO DETERMINE ROOT CAUSE, THE NEED FOR CORRECTIVE ACTION HAS NOT BEEN INDICATED. DEPUY CONSIDERS THE INVESTIGATION CLOSED AT THIS TIME. SHOULD THE PRODUCT AND/OR ADDITIONAL INFORMATION BE RECEIVED, THE INVESTIGATION WILL BE RE-OPENED.

    Additional Manufacturer Narrative · 1

    THIS COMPLAINT IS STILL UNDER INVESTIGATION. DEPUY WILL NOTIFY THE FDA OF THE RESULTS OF THIS INVESTIGATION ONCE IT HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    PINNACLE MOM REVISION. REASON NOT PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    51142 PINNACLE SECTOR II CUP 56MM ACETABULAR CUP KWA DEPUY SYNTHES B3XF81000

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Required Intervention