BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CORAIL2 STD SIZE 10

    MDR report key: 3802722 · Received May 9, 2014

    Report

    Report Number
    1818910-2014-18445
    Event Type
    Injury
    Date Received
    May 9, 2014
    Date of Event
    January 12, 2011
    Report Date
    April 14, 2014
    Manufacturer
    DEPUY FRANCE SAS REG. # 3003895575
    Product Code
    KWA
    PMA / PMN Number
    PK042992
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    ATTORNEY

    Narratives

    Additional Manufacturer Narrative · 1

    THIS COMPLAINT IS STILL UNDER INVESTIGATION. DEPUY WILL NOTIFY THE FDA OF THE RESULTS OF THIS INVESTIGATION ONCE IT HAS BEEN COMPLETED.

    Additional Manufacturer Narrative · 1

    EXAMINATION OF THE REPORTED DEVICES WAS NOT POSSIBLE AS THEY WERE NOT RETURNED. REASON FOR REVISION HAS NOT BEEN PROVIDED. IT HAS NOT BEEN CONFIRMED THE PATIENT HAS BEEN REVISED. A SEARCH OF THE COMPLAINTS DATABASES FINDS NO OTHER RELATED REPORTS AGAINST THE PRODUCT AND LOT CODE COMBINATIONS SINCE THEIR RELEASE TO DISTRIBUTION. NO ADDITIONAL EVENT INFORMATION OR INVESTIGATIONAL INPUTS WERE PROVIDED TO CUSTOMER QUALITY. THE INVESTIGATION CAN DRAW NO CONCLUSION WITH THE INFORMATION PROVIDED. BASED ON THE INABILITY TO DETERMINE ROOT CAUSE, THE NEED FOR CORRECTIVE ACTION HAS NOT BEEN INDICATED. DEPUY CONSIDERS THE INVESTIGATION CLOSED AT THIS TIME. SHOULD ADDITIONAL INFORMATION BE RECEIVED, THE INFORMATION WILL BE REVIEWED AND THE INVESTIGATION WILL BE RE-OPENED AS NECESSARY.

    Description of Event or Problem · 1

    REPORT OF FORMAL CLAIM RECEIVED. REVISION DATE CONFIRMED. NO REASON FOR REVISION RECEIVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    280737 CORAIL2 STD SIZE 10 HIP FEMORAL STEM/SLEEVE KWA DEPUY FRANCE SAS REG. # 3003895575 2931980

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention