BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR UNI FEMORAL IMPL SIZE 49

    MDR report key: 3171781 · Received June 17, 2013

    Report

    Report Number
    1818910-2013-06305
    Event Type
    Injury
    Date Received
    June 17, 2013
    Date of Event
    March 10, 2015
    Report Date
    March 10, 2015
    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
    CA, 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.

    Additional Manufacturer Narrative · 1

    DEPUY STILL CONSIDERS THE INVESTIGATION CLOSED.

    Description of Event or Problem · 1

    LITIGATION PAPERS ALLEGE: ON OR ABOUT (B)(4) 2009, PATIENT WAS IMPLANTED WITH A DEPUY ASR HIP IMPLANT. PATIENT HAS EXPERIENCED PHYSICAL INJURY, PAIN, BODILY IMPAIRMENT, AND HIGH LEVELS OF TOXIC METAL IN HIS BLOOD STREAM. PATIENT WILL BE REQUIRED TO UNDERGO A REVISION SURGERY. ***UPDATE*** (B)(4) 2012 PLAINTIFF'S PRELIMINARY DISCLOSURE (PPD) RECEIVED (B)(4) 2012. CHANGED UNK ASR HIP TO ASR CUP ADDED FEMORAL HEAD,

    Description of Event or Problem · 1

    UPDATE (B)(6) 2015: REC'D DER WITH REVISION DATE, PATIENT ACTIVITY, SURGEON, SALES REP, STEM AND SLEEVE DETAILS, HIP SIDE (RIGHT). (B)(6) 2015.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    272783 ASR UNI FEMORAL IMPL SIZE 49 FEMORAL HEAD HIP IMPLANT KWA DEPUY INTERNATIONAL 2743846

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Other| R