BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TOTAL ASR ACET IMP SIZE 56

    MDR report key: 3173904 · Received June 17, 2013

    Report

    Report Number
    1818910-2013-19072
    Event Type
    Injury
    Date Received
    June 17, 2013
    Date of Event
    September 12, 2012
    Report Date
    August 4, 2015
    Manufacturer
    DEPUY INTL., LTD. - 8010379
    Product Code
    KWA
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UK
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    NO 510(K) NUMBER PROVIDED BECAUSE THIS IMPLANT IS SOLD INTERNATIONALLY WITH DIFFERENT INDICATIONS FOR USE; IT IS CURRENTLY SOLD IN THE US UNDER A DIFFERENT PART NUMBER. THE CORRECTION/REMOVAL REPORTING NUMBER LISTED APPLIES TO THE CORRESPONDING PRODUCT CODE SOLD DOMESTICALLY. 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

    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.

    Additional Manufacturer Narrative · 1

    DEPUY STILL CONSIDERS THIS CASE CLOSED TO CAPA AT THIS TIME.

    Description of Event or Problem · 1

    ASR REVISION; ASR HIP RESURFACING SYSTEM - RIGHT; REASON(S) FOR REVISION: UNKNOWN - KID (B)(4).

    Description of Event or Problem · 1

    UPDATE - UPDATED TYPE OF REPLACEMENT, ADDED REASONS FOR REVISION X 3, ADDED ADDITIONAL SURGEON, ADDED STEM AND SLEEVE, FILED OUT ALL MW FIELDS, ALL EXPIRY AND MANUFACTURING DATES. TAKEN FROM SCF DATED 4TH AUGUST 2015 - (B)(4). ADDED CLAIMSUITE. (B)(4). XL. REASONS FOR REVISION : CUP LOOSENING, PAIN, ALVAL/SOFT TISSUE REACTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    272933 TOTAL ASR ACET IMP SIZE 56 HIP ACETABULAR CUP KWA DEPUY INTL., LTD. - 8010379 2335614

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention