BEUDAMED
    FDA Adverse Event Injury Summary report: N

    5.0MM DIA TPRD HD PER SCRW 35

    MDR report key: 3126443 · Received May 23, 2013

    Report

    Report Number
    1818910-2013-17532
    Event Type
    Injury
    Date Received
    May 23, 2013
    Date of Event
    January 7, 2013
    Report Date
    April 25, 2013
    Manufacturer
    DEPUY ORTHOPAEDICS INC US
    Product Code
    JDI
    PMA / PMN Number
    PK861979
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    ATTORNEY

    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. A SEARCH OF THE COMPLAINT DATABASE FOUND NO ADDITIONAL RELATED REPORTS FOR THE LOT CODES 2213913, A3PD21000, AF2FF4000, ZL9LT4000, X5FEC1000, Y2REG4000, Z5NKW4000, AND X52CX4000. A SEARCH OF THE COMPLAINT DATABASE FINDS ADDITIONAL REPORTED INCIDENTS AGAINST LOT CODE AA5DA4000 SINCE ITS RELEASE FOR DISTRIBUTION; HOWEVER, A PREVIOUS REVIEW OF THE DEVICE HISTORY RECORDS DID NOT REVEAL ANY RELATED MANUFACTURING ANOMALIES. A SEARCH OF THE COMPLAINT DATABASE FINDS ADDITIONAL REPORTED INCIDENTS AGAINST LOT CODE 1901192 SINCE ITS RELEASE FOR DISTRIBUTION; HOWEVER, A REVIEW OF THE DEVICE HISTORY RECORDS DID NOT REVEAL ANY RELATED MANUFACTURING ANOMALIES. THE INVESTIGATION COULD NOT VERIFY OR IDENTIFY ANY PRODUCT CONTRIBUTION TO THE REPORTED EVENT WITH THE INFORMATION PROVIDED. BASED ON THE INABILITY TO DETERMINE A ROOT CAUSE, THE NEED FOR CORRECTIVE ACTION WAS NOT INDICATED. DEPUY CONSIDERS THE INVESTIGATION CLOSED. SHOULD ADDITIONAL INFORMATION BE RECEIVED, THE INFORMATION WILL BE REVIEWED AND THE INVESTIGATION WILL BE RE-OPENED AS NECESSARY.

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    LITIGATION ALLEGES THAT THE PATIENT SUFFERS FROM PAIN, DISCOMFORT, INFLAMMATION, DIFFICULTY AMBULATING, AND DISABILITY. IT IS ALSO ALLEGED THAT THE PATIENT FELT THE HIP MOVE OUT OF PLACE. AN X-RAY CONFIRMED THAT THE ACETABULAR COMPONENT MOVED. UPDATE: 4/25/2013 - PFS WAS RECEIVED FROM LEGAL, MEDICAL RECORDS WERE RECEIVED FROM LEGAL, AND PART/LOT INFORMATION WAS IDENTIFIED. RECORDS INDICATE THAT THE REVISION ON (B)(6) 2006 WAS DUE TO A LOOSE ACETABULAR SHELL. THE REVISION ON (B)(6) 2007 WAS ALSO DUE TO A LOOSE SHELL AND THE PATIENT HAD BONE DEFICIENCY. RECORDS ARE AVAILABLE FOR FURTHER REVIEW.

    Description of Event or Problem · 1

    PPF ALLEGED ELEVATED METAL IONS. ADDED STEM, LINER AND HEAD. UPDATED PATIENT IDENTIFIER AND ASSOCIATED CONTACTS. DOI: (B)(6) 2006 DOR: (B)(6) 2007 (RIGHT HIP). SEE (B)(4) FOR RIGHT HIP 1ST REVISION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    228252 5.0MM DIA TPRD HD PER SCRW 35 BONE SCREWS AND PINS : SCREWS JDI DEPUY ORTHOPAEDICS INC US Y2REG4000

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Required Intervention