BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TOTAL ASR ACET IMP SIZE 46

    MDR report key: 3183381 · Received June 21, 2013

    Report

    Report Number
    1818910-2013-19608
    Event Type
    Injury
    Date Received
    June 21, 2013
    Date of Event
    November 13, 2012
    Report Date
    July 3, 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. REF. (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.

    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.

    Description of Event or Problem · 1

    ADDITIONAL REASONS FOR REVISION: LIMITED RANGE OF MOTION, NOISE.

    Description of Event or Problem · 1

    ASR REVISION, ASR XL ¿ LEFT, REASON(S) FOR REVISION: PAIN, ALVAL/SOFT TISSUE REACTION; METALLOSIS.

    Description of Event or Problem · 1

    UPDATE 3 JUL 2015: REC'D KENNEDYS UPDATE WITH ADDITIONAL SURGEON. HIP SIDE CONFIRMED AS RIGHT. MARKED COM AS LEGAL AND ADDED KID. FILLED IN ALL MISSING MW FIELDS, MANUFACTURING AND EXPIRY DATES, MANUFACTURING LOCATIONS FOR ALL PRODUCTS. (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    283454 TOTAL ASR ACET IMP SIZE 46 ACETABULAR CUP KWA DEPUY INTL., LTD. - 8010379 2204644

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention