BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TOTAL ASR ACET IMP SIZE 62

    MDR report key: 3230711 · Received July 16, 2013

    Report

    Report Number
    1818910-2013-21394
    Event Type
    Injury
    Date Received
    July 16, 2013
    Date of Event
    June 25, 2013
    Report Date
    July 3, 2015
    Manufacturer
    DEPUY INTERNATIONAL LTD.8010379
    Product Code
    KWA
    Removal / Correction Number
    Z-1749/1816-2011
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    DEPUY STILL CONSIDERS THIS INVESTIGATION CLOSED.

    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.

    Description of Event or Problem · 1

    UPDATE (B)(6) 2015: REC'D (B)(6) ECLAIM, MARKED COM AS LEGAL, ADDED KID, CHANGED IMPLANT DATE, FILLED IN ALL MISSING MW FIELDS, MAND/EXP DATE FOR PRODUCTS, MAN LOCATION.

    Description of Event or Problem · 1

    REASON(S) FOR REVISION: PAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    330194 TOTAL ASR ACET IMP SIZE 62 HIP ACETABULAR CUP KWA DEPUY INTERNATIONAL LTD.8010379 1177941

    Patients

    Seq Age Sex Outcome Treatment
    1