BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR UNI FEMORAL IMPL SIZE 51

    MDR report key: 3083328 · Received April 29, 2013

    Report

    Report Number
    1818910-2013-02894
    Event Type
    Injury
    Date Received
    April 29, 2013
    Report Date
    June 30, 2011
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KWA
    PMA / PMN Number
    K040627
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    ATTORNEY

    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. REF. (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.

    Description of Event or Problem · 1

    LITIGATION PAPERS ALLEGE THE PATIENT SUFFERED AND CONTINUES TO SUFFER SYMPTOMS INCLUDING, BUT NOT LIMITED TO PAIN, WEAKNESS, AND DIFFICULTY WITH EVEN SIMPLE DAILY LIVING ACTIVITIES. IT IS FURTHER ALLEGED THAT THE PATIENT HAS AN ELEVATED LEVEL OF COBALT AND CHROMIUM METAL IONS IN HIS BLOOD STREAM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    184827 ASR UNI FEMORAL IMPL SIZE 51 FEMORAL HEAD HIP IMPLANT KWA DEPUY INTERNATIONAL 2835760

    Patients

    Seq Age Sex Outcome Treatment
    1 Other