BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR UNI FEMORAL IMPL SIZE 46

    MDR report key: 3171780 · Received June 17, 2013

    Report

    Report Number
    1818910-2013-06304
    Event Type
    Injury
    Date Received
    June 17, 2013
    Report Date
    August 5, 2011
    Manufacturer
    DEPUY INTERNATIONAL
    Product Code
    KWA
    PMA / PMN Number
    K040627
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    ATTORNEY

    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. (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.

    Description of Event or Problem · 1

    PATIENT IS SEEKING LEGAL ACTION. FORMAL LITIGATION PAPERS RECEIVED WHICH ALLEGE PATIENT SUFFERS FROM SEVERE PAIN AND REQUIRES ONGOING MEDICAL CARE. IT IS FURTHER ALLEGED THAT THE PATIENT WILL NEED TO UNDERGO AND RECOVER FROM A PAINFUL HIP REVISION SURGERY. ***UPDATE*** (B)(4) 2011 PLAINTIFF'S PRELIMINARY DISCLOSURE (PPD) RECEIVED (B)(4) 2011. CHANGED UNK ASR HIP TO ASR CUP ADDED FEMORAL HEAD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    273244 ASR UNI FEMORAL IMPL SIZE 46 FEMORAL HEAD HIP IMPLANT KWA DEPUY INTERNATIONAL 2708619

    Patients

    Seq Age Sex Outcome Treatment
    1 Other