BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SROM*STM LG 36+8L 22X17X230N

    MDR report key: 2950488 · Received February 8, 2013

    Report

    Report Number
    1818910-2013-12047
    Event Type
    Injury
    Date Received
    February 8, 2013
    Date of Event
    January 25, 2013
    Report Date
    January 25, 2013
    Manufacturer
    DEPUY (IRELAND)
    Product Code
    JDI
    PMA / PMN Number
    PK851422
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    PATIENT WAS REVISED TO ADDRESS PAIN AND LOOSENING OF THE SLEEVE AND STEM. SURGEON QUESTIONS BONE QUALITY AND SLIGHT UNDER-SIZING OF IMPLANTS, WHICH LED TO THE LOOSENING. DOI (B)(6) 2006 - DOR (B)(6) 2013 (LEFT HIP). THE DEVICES ASSOCIATED WITH THIS REPORT WERE NOT RETURNED. A COMPLAINT DATABASE SEARCH FINDS NO OTHER REPORTED INCIDENTS AGAINST THE PROVIDED PRODUCT AND LOT COMBINATIONS SINCE THEIR RELEASE FOR DISTRIBUTION. PER FOLLOW UP; PATIENT X-RAYS ARE NOT AVAILABLE FOR EXAMINATION. THE INVESTIGATION COULD NOT DRAW ANY CONCLUSIONS REGARDING THE REPORTED EVENT. BASED ON THE INABILITY TO DETERMINE A ROOT CAUSE, THE NEED FOR CORRECTIVE ACTION WAS NOT INDICATED. DEPUY CONSIDERS THE INVESTIGATION CLOSED AT THIS TIME. SHOULD THE PRODUCT OR ADDITIONAL INFORMATION BE RECEIVED TO CHANGE THE OUTCOME OF THE PERFORMED INVESTIGATION, THE COMPLAINT 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

    PATIENT WAS REVISED TO ADDRESS PAIN AND LOOSENING OF THE SLEEVE AND STEM. SURGEON QUESTIONS BONE QUALITY AND SLIGHT UNDERSIZING OF IMPLANTS, WHICH LED TO THE LOOSENING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    53742 SROM*STM LG 36+8L 22X17X230N FEMORAL HIP STEM JDI DEPUY (IRELAND) 1830316

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Required Intervention