BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PINNACLE MTL INS NEUT36IDX52OD

    MDR report key: 3003315 · Received March 14, 2013

    Report

    Report Number
    1818910-2013-13768
    Event Type
    Injury
    Date Received
    March 14, 2013
    Date of Event
    October 13, 2011
    Report Date
    March 5, 2013
    Manufacturer
    8010379 DEPUY INTERNATIONAL
    Product Code
    KWA
    PMA / PMN Number
    PK003523
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    ATTORNEY

    Narratives

    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.

    Additional Manufacturer Narrative · 1

    EXAMINATION OF THE REPORTED DEVICES WAS NOT POSSIBLE AS THEY WERE NOT RETURNED. REASON FOR REVISION HAS NOT BEEN PROVIDED AND IT IS NOT KNOWN IF THE PATIENT HAS BEEN REVISED. FURTHER INFORMATION HAS NOT BEEN PROVIDED TO DEPUY CUSTOMER QUALITY. 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 THIS INVESTIGATION CLOSED. SHOULD THE PRODUCT OR ADDITIONAL INFORMATION THAT CHANGES THIS CONCLUSION BE RECEIVED, THE INVESTIGATION WILL BE REOPENED.

    Description of Event or Problem · 1

    REVISION OF PINNACLE MOM IMPLANTS. REASON NOT PROVIDED, REVISION DATE CONFIRMED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    106929 PINNACLE MTL INS NEUT36IDX52OD METAL INSERT KWA 8010379 DEPUY INTERNATIONAL 2378921

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention