BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TOTAL ASR FEM IMP SIZE 57

    MDR report key: 2982893 · Received February 28, 2013

    Report

    Report Number
    1818910-2013-02683
    Event Type
    Injury
    Date Received
    February 28, 2013
    Date of Event
    January 21, 2013
    Report Date
    February 20, 2013
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KXA
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    EI
    Reporter Occupation
    PATIENT

    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. (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

    ASR REVISION; ASR RESURFACING - LEFT HIP; REASON(S) FOR REVISION: PAIN; ALVAL/SOFT TISSUE REACTION; INCREASE IN ION LEVELS; ABNORMAL MRI; STIFFNESS SENSATION OF JAMMING IN LEFT HIP; LIMITED AND IRRITABLE RANGE OF MOVEMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    87946 TOTAL ASR FEM IMP SIZE 57 ASR TOTAL HIP REPLACEMENT KXA DEPUY INTERNATIONAL 2345758

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention