BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PRODIGY SM STAT SHT LT 10.5MM

    MDR report key: 3113313 · Received May 15, 2013

    Report

    Report Number
    1818910-2013-17091
    Event Type
    Injury
    Date Received
    May 15, 2013
    Date of Event
    May 2, 2013
    Report Date
    May 2, 2013
    Manufacturer
    1818910 DEPUY ORTHOPAEDICS, INC.
    Product Code
    LPH
    PMA / PMN Number
    PK931641
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    PHYSICIAN

    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

    THE DEVICES ASSOCIATED WITH THIS REPORT WERE NOT RETURNED. PROVIDED PRODUCT PHOTOGRAPHS CONFIRM A DISTAL MATERIAL FRACTURE OF THE EXPLANTED STEM. NO PHOTOGRAPHS WERE PROVIDED OF THE LINER TO CONFIRM THE REPORTED MATERIAL WEAR. IT WOULD NOT HOWEVER BE UNREASONABLE TO FIND POLY MATERIAL WEAR AFTER THE LENGTH OF TIME REPORTED AS IMPLANTED. REVIEW OF THE DEVICE HISTORY RECORDS DID NOT REVEAL ANY RELATED MANUFACTURING DEVIATIONS OR ANOMALIES. REQUESTS FOR ADDITIONAL INVESTIGATIONAL INPUTS WERE MADE IN ACCORDANCE WITH WI-7915 APPENDIX A; REV. D. NO ADDITIONAL INFORMATION WAS OBTAINED. THE INVESTIGATION COULD NOT DRAW ANY CONCLUSIONS REGARDING THE REPORTED EVENT. BASED ON THE INABILITY TO DETERMINE A ROOT CAUSE, THE NEED FOR CORRECTIVE ACTION WAS NOT INDICATED. DEPUY CONSIDERS THE INVESTIGATION CLOSED AT THIS TIME. SHOULD THE PRODUCT OR ADDITIONAL INFORMATION BE RECEIVED TO CHANGE THE OUTCOME OF THE PERFORMED INVESTIGATION, THE COMPLAINT WILL BE RE-OPENED.

    Description of Event or Problem · 1

    PATIENT WAS REVISED TO ADDRESS A BROKEN, LOOSE STEM AND ECCENTRIC POLY WEAR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    215289 PRODIGY SM STAT SHT LT 10.5MM FEMORAL HIP STEM LPH 1818910 DEPUY ORTHOPAEDICS, INC. S74BF1004

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Required Intervention