BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR ACETABULAR IMPLANT 60

    MDR report key: 3102761 · Received May 9, 2013

    Report

    Report Number
    1818910-2013-05746
    Event Type
    Injury
    Date Received
    May 9, 2013
    Date of Event
    January 15, 2013
    Report Date
    December 8, 2015
    Manufacturer
    DEPUY INTERNATIONAL LTD - 8010379
    Product Code
    KWA
    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. 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. THE CORRECTION/REMOVAL REPORTING NUMBER LISTED APPLIES TO THE CORRESPONDING PRODUCT CODE SOLD DOMESTICALLY.

    Additional Manufacturer Narrative · 1

    DEPUY STILL CONSIDERS THIS CASE CLOSED TO CAPA. IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE.

    Additional Manufacturer Narrative · 1

    IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE. DEPUY STILL CONSIDERS THIS CASE CLOSED TO CAPA.

    Description of Event or Problem · 1

    ASR REVISION; ASR XL - LEFT; REASON(S) FOR REVISION: PAIN, HIP IS UNDERPERFORMING, MRI SHOWED PERI PROSTHETIC FLUID COLLECTION AROUND FEMORAL COMP.

    Description of Event or Problem · 1

    UPDATE 8 DEC. 2015: UPDATED AS LEGAL. ADDED PATIENT NAME, GENDER AND DATE OF BIRTH. ADDED ADDITIONAL SURGEON, ADDED MANUFACTURE AND EXPIRY DATES FOR PRODUCTS. TAKEN FROM NEW ASR LEGAL CLAIM

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    203835 ASR ACETABULAR IMPLANT 60 ASR TOTAL HIP REPLACEMENT KWA DEPUY INTERNATIONAL LTD - 8010379 2140307

    Patients

    Seq Age Sex Outcome Treatment
    1 46 YR Required Intervention