BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR UNI FEMORAL IMPL SIZE 53

    MDR report key: 3243985 · Received July 23, 2013

    Report

    Report Number
    1818910-2013-21973
    Event Type
    Injury
    Date Received
    July 23, 2013
    Date of Event
    October 7, 2013
    Report Date
    April 11, 2014
    Manufacturer
    DEPUY INTL., LTD. - 8010379
    Product Code
    KWA
    PMA / PMN Number
    PK040627
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    ATTORNEY

    Narratives

    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 INVESTIGATION CLOSED.

    Additional Manufacturer Narrative · 1

    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 THIS INVESTIGATION CLOSED.

    Description of Event or Problem · 1

    LITIGATION RECEIVED ALLEGING THAT THE PATIENT SUFFERS FROM THE ACETABULAR CUP PRODUCING METALLIC DEBRIS, LOOSENING FROM THE ACETABULUM, PAIN, AND ABNORMAL BLOOD METAL ION CONCENTRATIONS.COMMENT: IT SHOULD BE NOTED THAT THE LAW FIRM USES THE SAME (OR SIMILAR) COMPLAINT FOR ALL PATIENTS, SO IT IS POSSIBLE THESE SYMPTOMS ARE NOT SPECIFIC TO THIS PATIENT.

    Description of Event or Problem · 1

    **UPDATE** (B)(4) 2013 - PLAINTIFF¿S PRELIMINARY DISCLOSURE FORM WAS RECEIVED, WHICH IDENTIFIED DOB AND PART/LOT INFORMATION. THE COMPLAINT AND ASSOCIATED MDRS WERE UPDATED. THERE WAS NO NEW INFORMATION THAT WOULD CHANGE THE OUTCOME OF THE INVESTIGATION.

    Description of Event or Problem · 1

    UPDATE REC¿D 04/11/2014 - PLAINTIFF¿S PRELIMINARY DISCLOSURE FORM WITH MEDICAL RECORDS WAS RECEIVED, WHICH IDENTIFIED DOR INFORMATION. THE COMPLAINT AND ASSOCIATED MDRS WERE UPDATED. THERE WAS NO NEW INFORMATION THAT WOULD CHANGE THE OUTCOME OF THE INVESTIGATION. THE COMPLAINT WAS UPDATED ON: 05/05/2014.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    343083 ASR UNI FEMORAL IMPL SIZE 53 FEMORAL HEAD KWA DEPUY INTL., LTD. - 8010379 2183575

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Other