BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TAPER SLEEVE ADAPTER 12/14 +2

    MDR report key: 3243746 · Received July 23, 2013

    Report

    Report Number
    1818910-2013-21942
    Event Type
    Injury
    Date Received
    July 23, 2013
    Date of Event
    November 9, 2012
    Report Date
    April 29, 2015
    Manufacturer
    DEPUY INTL., LTD. - 8010379
    Product Code
    JDI
    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

    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 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

    DEPUY STILL CONSIDERS THE INVESTIGATION CLOSED. SHOULD ADDITIONAL INFORMATION BE RECEIVED THE INVESTIGATION WILL BE REOPENED.

    Additional Manufacturer Narrative · 1

    DEPUY STILL CONSIDERS THE INVESTIGATION CLOSED.

    Description of Event or Problem · 1

    REASON(S) FOR REVISION: UNKNOWN.

    Description of Event or Problem · 1

    UPDATE: APRIL 19, 2017. REASONS FOR REVISION: PAIN / ALVAL /SOFT TISSUE REACTION.

    Description of Event or Problem · 1

    UPDATE 29 APR 2015: REC'D CRAWFORDS CLAIMSUITE, SURGEON, ADDITIONAL HOSPITAL - (B)(6), FILE HANDLER, MW FIELDS, MANUFACTURING DATE AND LOCATION, EXPIRY DATES FOR ALL PRODUCTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    342276 TAPER SLEEVE ADAPTER 12/14 +2 HIP FEMORAL STEM/SLEEVE JDI DEPUY INTL., LTD. - 8010379 1850838

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention