BEUDAMED
    FDA Adverse Event Injury Summary report: N

    M2A TPR HI CARBON 41/32MM LNR

    MDR report key: 3372524 · Received September 27, 2013

    Report

    Report Number
    0001825034-2013-04231
    Event Type
    Injury
    Date Received
    September 27, 2013
    Date of Event
    August 27, 2013
    Report Date
    August 29, 2013
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    KWY
    PMA / PMN Number
    PK003363
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    CURRENT INFORMATION IS INSUFFICIENT TO PERMIT A CONCLUSION AS TO THE CAUSE OF THE EVENT. REVIEW OF DEVICE HISTORY RECORDS SHOW THAT LOT RELEASED WITH NO RECORDED ANOMALY OR DEVIATION. THERE ARE WARNINGS IN THE PACKAGE INSERT THAT STATE THAT THIS TYPE OF EVENT CAN OCCUR: UNDER POSSIBLE ADVERSE EFFECTS, NUMBER 1 STATES, "MATERIAL SENSITIVITY REACTIONS." THIS REPORT IS NUMBER 3 OF 3 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2013-04229 / 04231).

    Additional Manufacturer Narrative · 1

    EXAMINATION OF RETURNED DEVICE FOUND NO EVIDENCE OF PRODUCT NON-CONFORMANCES. MODERATE WEAR WAS NOTED ON THE MODULAR HEAD THIS REPORT IS NUMBER 3 OF 3 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2013-04229-1/04231-1).

    Description of Event or Problem · 1

    IT WAS REPORTED PATIENT UNDERWENT A TOTAL HIP ARTHROPLASTY ON (B)(6) 2010. SUBSEQUENTLY, PATIENT WAS REVISED ON (B)(6) 2013, DUE TO SWELLING AND PSEUDOTUMOR. NO FURTHER INFORMATION HAS BEEN PROVIDED TO DATE.

    Description of Event or Problem · 1

    IT WAS REPORTED PATIENT UNDERWENT A RIGHT TOTAL HIP ARTHROPLASTY ON (B)(6), 2010. SUBSEQUENTLY, PATIENT WAS REVISED ON (B)(6), 2013 DUE TO SWELLING AND PSEUDOTUMOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    489988 M2A TPR HI CARBON 41/32MM LNR PROSTHESIS, HIP KWY BIOMET ORTHOPEDICS N/A 019610

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Hospitalization| R