BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR UNI FEMORAL IMPL SIZE 51

    MDR report key: 3182670 · Received June 21, 2013

    Report

    Report Number
    1818910-2013-04471
    Event Type
    Injury
    Date Received
    June 21, 2013
    Date of Event
    October 22, 2014
    Report Date
    January 26, 2015
    Manufacturer
    DEPUY ORTHOPAEDICS, INC. 1818910
    Product Code
    KWA
    PMA / PMN Number
    K040627
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, 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

    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 INVESTIGATION CLOSED.

    Additional Manufacturer Narrative · 1

    PRODUCT COMPLAINT # (B)(4). INVESTIGATION SUMMARY ==> 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. THE INVESTIGATION REGARDING THE ROOT CAUSE(S) AND/OR CORRECTIVE ACTIONS WAS CONDUCTED UNDER MDD CAPA-(B)(4). ONGOING POST MARKET SURVEILLANCE IS CONDUCTED PER OUR PROCEDURES FOR THIS PRODUCT. IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE.

    Description of Event or Problem · 1

    LITIGATION PAPERS ALLEGE: PATIENT WAS IMPLANTED WITH A DEPUY ASR HIP IMPLANT ON HIS RIGHT SIDE ON OR ABOUT (B)(6) 2006. PATIENT WAS IMPLANTED WITH A DEPUY ASR HIP IMPLANT ON HIS LEFT SIDE ON OR ABOUT (B)(6) 2007. PATIENT EXPERIENCED PAIN. PATIENT WILL BE HAVING THE LEFT ASR HIP EXPLANTED ON OR ABOUT (B)(6) 2011, BUT HAS NOT YET SCHEDULED AN EXPLANTATION OF THE RIGHT ASR HIP IMPLANT.

    Description of Event or Problem · 1

    UPDATE REC¿D (B)(6) 2015 - MEDICAL RECORDS RECEIVED. PATIENT WAS REVISED TO ADDRESS LEFT HIP PAIN, A PSEUDOTUMOR AND ELEVATED METAL ION LEVELS. UPON REVISION, TRUNNIONOSIS, BLACK DEBRIS, ACETABULAR CUP LOOSENING, ADVERSE LOCAL TISSUE REACTION AND CLEAR TANNISH FLUID WERE NOTED. THE STEM AND SLEEVE ARE BEING ADDED TO THE COMPLAINT. THIS COMPLAINT WAS UPDATED ON: (B)(6) 2015.

    Description of Event or Problem · 1

    COMPLAINT DESCRIPTION: NEW (B)(4) RECORD CREATED IN ORDER TO UPDATE (B)(4) COMPLAINT NUMBER (B)(4). REASON FOR ORIGINAL COMPLAINT ¿ LITIGATION PAPERS ALLEGE: PATIENT WAS IMPLANTED WITH A DEPUY ASR HIP IMPLANT ON HIS LEFT SIDE ON OR ABOUT (B)(6) 2007. PATIENT EXPERIENCED PAIN. PATIENT WILL BE HAVING THE LEFT ASR HIP EXPLANTED ON OR ABOUT (B)(6) 2011, BUT HAS NOT YET SCHEDULED AN EXPLANTATION OF THE RIGHT ASR HIP IMPLANT. UPDATE** 07/11/2011: PLAINTIFF'S PRELIMINARY DISCLOSURE (PPD) FORMS, IMPLANT STICKERS AND MEDICAL RECORDS RECEIVED WHICH IDENTIFIED PART/LOT INFORMATION AND DATE OF IMPLANT. COMPLAINT FILE AND PRODUCTS UPDATED, FEMORAL HEADS ADDED, MDR DECISION TREES COMPLETED AND THE APPROPRIATE MDRS FILED. THE DOCUMENTS HAVE BEEN ATTACHED TO THE FILE. THERE IS NO NEW INFORMATION THAT WOULD CHANGE THE OUTCOME OF THE INVESTIGATION. UPDATE REC¿D 1/26/2015 - MEDICAL RECORDS RECEIVED. PATIENT WAS REVISED TO ADDRESS LEFT HIP PAIN, A PSEUDOTUMOR AND ELEVATED METAL ION LEVELS. UPON REVISION, TRUNNIONOSIS, BLACK DEBRIS, ACETABULAR CUP LOOSENING, ADVERSE LOCAL TISSUE REACTION AND CLEAR TANNISH FLUID WERE NOTED. THE STEM AND SLEEVE ARE BEING ADDED TO THE COMPLAINT. THIS COMPLAINT WAS UPDATED ON: 02/18/2015.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    282587 ASR UNI FEMORAL IMPL SIZE 51 FEMORAL HEAD HIP IMPLANT KWA DEPUY ORTHOPAEDICS, INC. 1818910 2153760

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Required Intervention