BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TOTAL ASR ACET IMP SIZE 56

    MDR report key: 3140002 · Received May 31, 2013

    Report

    Report Number
    1818910-2013-06326
    Event Type
    Injury
    Date Received
    May 31, 2013
    Date of Event
    March 26, 2013
    Report Date
    September 1, 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
    IT
    Reporter Occupation
    PATIENT

    Narratives

    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. (B)(4).

    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.

    Description of Event or Problem · 1

    UPDATE 3 SEPTEMBER 2015: UPDATED HIP SIDE TO RIGHT HIP. UPDATED TO LEGAL AND ATTACHED LEGAL CLAIM. UPDATED REASONS FOR REVISION TO INCLUDE IMPLANT NOISE (SQUEAK), ELEVATED COBALT & CHROMIUM LEVELS & METALLOSIS. ADDED PATIENT'S NAME AND DATE OF BIRTH, UPDATED GENDER. ADDED PRIMARY SURGERY HOSPITAL. ADDED KENNEDYS DETAILS AS COMPLAINANT. ADDED MANUFACTURE AND EXPIRY DATES FOR PRODUCTS. TAKEN FROM NEW ASR LEGAL CLAIM 2 SEPTEMBER 2015.

    Description of Event or Problem · 1

    ASR REVISION; ASR XL; REASON FOR REVISION - UNKNOWN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    241225 TOTAL ASR ACET IMP SIZE 56 HIP ACETABULAR CUP KWA DEPUY INTERNATIONAL LTD - 8010379 2185354

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Required Intervention