BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNIDENTIFIED ASR CUP OR HEAD

    MDR report key: 3191803 · Received June 26, 2013

    Report

    Report Number
    1818910-2013-19968
    Event Type
    Injury
    Date Received
    June 26, 2013
    Date of Event
    January 1, 2011
    Report Date
    July 22, 2014
    Manufacturer
    DEPUY INTERNATIONAL LTD.
    Product Code
    KWA
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    DEPUY STILL CONSIDERS THIS CASE CLOSED TO CAPA.

    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

    IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE. NO REVISION. NO SERIOUS INJURY AT THIS TIME.

    Description of Event or Problem · 1

    ASR REVISION. HIP TYPE UNKNOWN - LEFT HIP. REASON FOR REVISION- UNKNOWN. UPDATE RECEIVED 22 JULY 2014 - REVISION DATE REMOVED AS NO INDICATION THAT PRODUCT HAS BEEN REVISED. NEW FIELDS COMPLETED.

    Description of Event or Problem · 1

    ASR REVISION, LEFT HIP, REASON FOR REVISION- UNKNOWN KID.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    290491 UNIDENTIFIED ASR CUP OR HEAD HIP OTHER IMPLANT KWA DEPUY INTERNATIONAL LTD. UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention