BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR ACETABULAR CUPS 58

    MDR report key: 3850060 · Received June 4, 2014

    Report

    Report Number
    1818910-2014-20234
    Event Type
    Injury
    Date Received
    June 4, 2014
    Date of Event
    March 18, 2014
    Report Date
    November 17, 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
    UT, 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. 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. REF. WWCAPA (B)(4). DEPUY CONSIDERS THIS INVESTIGATION CLOSED AT THIS TIME. SHOULD THE PRODUCT AND/OR ADDITIONAL INFORMATION BE RECEIVED, THE INVESTIGATION WILL BE RE-OPENED.

    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 THE INVESTIGATION CLOSED.

    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.

    Description of Event or Problem · 1

    LITIGATION ALLEGES PAIN, INJURY, BODILY IMPAIRMENT, DEBILITATING LACK OF MOBILITY AND ELEVATED METAL ION LEVELS.

    Description of Event or Problem · 1

    UPDATE REC 11/17/2014 - MEDICAL RECORDS. RECEIVED. PATIENT REVISED TO ADDRESS OSTEOLYSIS, METALLOSIS, METAL DEBRIS AND EFFUSION. UPON REVISION, A PSEUDOTUMOR AND GRAYISH FLUID WERE NOTED. THE STEM AND SLEEVE ARE BEING ADDED FOR ELEVATED METAL ION LEVELS. THE STEM REMAINED IN SITU. THIS COMPLAINT WAS UPDATED ON: 12/16/2014.

    Description of Event or Problem · 1

    UPDATE REC'D 08/13/2014 - PLAINTIFF'S PRELIMINARY DISCLOSURE FORM WAS RECEIVED, WHICH IDENTIFIED DOB, DOI, AND DOR INFORMATION. INVOICE AS LOCATED. THE COMPLAINT AND ASSOCIATED MDR'S WERE UPDATED. THERE WAS NO NEW INFORMATION THAT WOULD CHANGE THE OUTCOME OF THE INVESTIGATION. THE COMPLAINT WAS UPDATED ON: 08/26/2014.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    326719 ASR ACETABULAR CUPS 58 HIP ACETABULAR CUP KWA DEPUY INTL., LTD - 8010379 1968921

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Other