BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TOTAL ASR FEM IMP SIZE 47

    MDR report key: 3003966 · Received March 14, 2013

    Report

    Report Number
    1818910-2013-03067
    Event Type
    Injury
    Date Received
    March 14, 2013
    Date of Event
    March 7, 2011
    Report Date
    March 13, 2013
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KXA
    Removal / Correction Number
    Z- 1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    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.

    Additional Manufacturer Narrative · 1

    DEPUY STILL CONSIDERS THE INVESTIGATION CLOSED.

    Additional Manufacturer Narrative · 1

    UPDATED DATA: (DATE OF REPORT); (EVENT DESCRIPTION); (DATE RECEIVED BY MANUFACTURER). 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

    ASR REVISION; HIP(S) TO BE REVISED: RIGHT; ASR HIP RESURFACING SYSTEM; REASON(S) FOR REVISION: COMPONENT LOOSENING, PAIN, ALVAL /SOFT TISSUE REACTION, DISLOCATION (NOT ARISING FROM TRAUMATIC EVENT).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE FEMORAL COMPONENT LOOSENED. ALL OTHER PREVIOUSLY REPORTED REASONS FOR REVISION STILL APPLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    107010 TOTAL ASR FEM IMP SIZE 47 ASR TOTAL HIP REPLACEMENT KXA DEPUY INTERNATIONAL 1199789

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR Required Intervention