FDA Adverse Event Injury Summary report: N

EXETER V40 STEM 44MM NO 0

MDR report key: 3012600 · Received March 20, 2013

Report

Report Number
0002249697-2013-01042
Event Type
Injury
Date Received
March 20, 2013
Date of Event
February 24, 2013
Report Date
February 25, 2013
Manufacturer
STRYKER ORTHOPAEDICS-MAHWAH
Product Code
JDI
PMA / PMN Number
K011623
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NZ
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

A SUPPLEMENTAL REPORT WILL BE SUBMITTED UPON COMPLETION OF THE INVESTIGATION.

Additional Manufacturer Narrative · 1

DATE OF BIRTH UPDATED. CORRECTED DATA: IMPLANT DATE. AN EVENT REGARDING STEM FRACTURE INVOLVING AN EXETER DEVICE WAS REPORTED. THE EVENT WAS CONFIRMED. DEVICE EVALUATION COULD NOT BE COMPLETED AS THE DEVICES ASSOCIATED WITH THE EVENT WERE NOT RETURNED. A REVIEW OF THE DEVICE HISTORY RECORDS COULD NOT BE PERFORMED AS THE LOT WAS UNKNOWN. THE INVESTIGATION CONCLUDED THAT THE ROOT CAUSE OF THIS EXETER STEM FRACTURE WAS A RESULT OF CYCLIC LOADING AT THE JUNCTION OF THE PROXIMAL LOOSE STEM AND THE WELL-FIXED DISTAL STEM RESULTED IN INEVITABLE FATIGUE FRACTURE OF THE STEM. NO FURTHER INVESTIGATION FOR THIS EVENT IS POSSIBLE AT THIS TIME.

Description of Event or Problem · 1

REVISION OF AN EXETER 44 #0 STEM. THE STEM HAD BEEN IN AROUND 5 YEARS AND HAD A COMPLETE TRANSVERSE FRACTURE MID EXETER STEM. FEMUR WAS INTACT.

Description of Event or Problem · 1

REVISION OF AN EXETER 44 #0 STEM. THE STEM HAD BEEN IN AROUND 5 YEARS AND HAD A COMPLETE TRANSVERSE FRACTURE MID EXETER STEM. FEMUR WAS INTACT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
116654 EXETER V40 STEM 44MM NO 0 IMPLANT JDI STRYKER ORTHOPAEDICS-MAHWAH UNK

Patients

Seq Age Sex Outcome Treatment
1 49 YR Hospitalization| O| R