BEUDAMED
    FDA Adverse Event Injury Summary report: N

    M2A-MAGNUM MODUALR HEAD SIZE 42MM

    MDR report key: 3170964 · Received June 14, 2013

    Report

    Report Number
    0001825034-2013-01963
    Event Type
    Injury
    Date Received
    June 14, 2013
    Date of Event
    March 30, 2010
    Report Date
    May 19, 2013
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    KWA
    PMA / PMN Number
    PK042037
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Additional Manufacturer Narrative · 1

    CURRENT INFORMATION IS INSUFFICIENT TO PERMIT A CONCLUSION AS TO THE CAUSE OF THE EVENT. REVIEW OF DEVICE HISTORY RECORDS SHOW THAT LOT RELEASED WITH NO RECORDED ANOMALY. THERE ARE WARNINGS IN THE PACKAGE INSERT THAT STATE THAT THIS TYPE OF EVENT CAN OCCUR: UNDER POSSIBLE ADVERSE EFFECTS, NUMBER 1 STATES, "MATERIAL SENSITIVITY REACTIONS." NUMBER 14 STATES, "INTRAOPERATIVE OR POSTOPERATIVE BONE FRACTURE AND/OR POSTOPERATIVE PAIN." NUMBER 15 STATES, "ELEVATED METAL ION LEVELS HAVE BEEN REPORTED WITH METAL-ON-METAL ARTICULATING SURFACES." THIS REPORT IS BASED ON ALLEGATIONS SET FORTH IN PLAINTIFF¿S COMPLAINT, AND THE ALLEGATIONS CONTAINED THEREIN ARE UNVERIFIED. THIS REPORT IS NUMBER 3 OF 4 MDRS FILED FOR THE SAME PATIENT (REFERENCE 1825034-2013-01961 / 01964).

    Description of Event or Problem · 1

    LEGAL COUNSEL FOR THE PATIENT REPORTS THAT PATIENT UNDERWENT RIGHT M2A TOTAL HIP ARTHROPLASTY ON (B)(6) 2007. REVIEW OF INVOICE HISTORY FOUND PATIENT UNDERWENT LEFT TOTAL HIP ARTHROPLASTY (B)(6) 2010. SUBSEQUENTLY, PATIENT UNDERWENT A LEFT REVISION PROCEDURE (B)(6) 2010 FOR AN UNKNOWN REASON. FURTHER REVIEW OF INVOICE HISTORY CONFIRMS PATIENT UNDERWENT A RIGHT REVISION PROCEDURE (B)(6) 2010 AND PATIENT ALLEGATIONS INCLUDE PAIN, DYSFUNCTION, METAL POISONING, METALLOSIS, AND LOSS OF RANGE OF MOTION. NO FURTHER INFORMATION HAS BEEN PROVIDED TO DATE. THIS REPORT IS BASED ON ALLEGATIONS SET FORTH IN PLAINTIFF¿S COMPLAINT AND THE ALLEGATIONS CONTAINED THEREIN ARE UNVERIFIED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    271294 M2A-MAGNUM MODUALR HEAD SIZE 42MM PROSTHESIS, HIP KWA BIOMET ORTHOPEDICS N/A 717850

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R