BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEPUY ASR XL FEM IMP SIZE 47

    MDR report key: 3191580 · Received June 26, 2013

    Report

    Report Number
    1818910-2013-19942
    Event Type
    Injury
    Date Received
    June 26, 2013
    Date of Event
    July 20, 2012
    Report Date
    March 18, 2015
    Manufacturer
    DEPUY INTERNATIONAL LTD.
    Product Code
    KXA
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    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

    ADDITIONAL NARRATIVE: 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

    ASR REVISION; RIGHT; RESURFACING; REASON FOR REVISION: UNKNOWN.

    Description of Event or Problem · 1

    ASR REVISION; RIGHT; RESURFACING. REASON FOR REVISION: UNKNOWN. UPDATE -ADDED A SLEEVE, FILE HANDLER DETAILS, (B)(4) NUMBER PREVIOUSLY MISSED , ADDED REASON FOR REVISION, SURGEON, AMENDED IMPLANT DATE, FILLED IN ALL MW FIELDS, MANUFACTURING AND EXPIRY DATES, ATTACHED SCF, QUERIED MISSING STEM. TAKEN FROM SCF DATED (B)(6) 2015 AND CLAIMSUITE DATED (B)(4) 2015. REASON(S) FOR REVISION: ALVAL / SOFT TISSUE REACTION. SURGEON'S NAME: (B)(6). SURGERY DATE: (B)(6) 2009. EMAIL RECEIVED - STEM DETAILS ARE UNAVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    290153 DEPUY ASR XL FEM IMP SIZE 47 HIP FEMORAL HEAD KXA DEPUY INTERNATIONAL LTD. 2801977

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention