BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OSS BOW COLLARED STEM 11 X 150

    MDR report key: 3951072 · Received July 22, 2014

    Report

    Report Number
    0001825034-2014-06349
    Event Type
    Injury
    Date Received
    July 22, 2014
    Date of Event
    January 27, 2014
    Report Date
    July 7, 2014
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    JDI
    PMA / PMN Number
    PK123501
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    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. THIS REPORT IS NUMBER 5 OF 5 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2014-01124 / 01125 & 06347 / 06349).

    Description of Event or Problem · 1

    IT WAS REPORTED PATIENT UNDERWENT A TOTAL HIP ARTHROPLASTY ON (B)(6) 2013. SUBSEQUENTLY, PATIENT WAS REVISED ON (B)(6) 2014 DUE TO DISLOCATION. THE MODULAR HEAD, LINER AND LOCKING RING WERE REMOVED AND REPLACED. PATIENT UNDERWENT A FURTHER REVISION PROCEDURE ON (B)(6) 2014 DUE TO DISLOCATION AFTER PATIENT WAS NONCOMPLIANT. IT WAS FURTHER REPORTED OSSEOUS SCLEROSIS AND HETEROTOPIC BONE FORMATION AROUND THE FEMORAL STEM WAS NOTED DURING THE REVISION PROCEDURE. THE MODULAR HEAD, LINER, LOCKING RING AND SCREW WERE REMOVED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    427649 OSS BOW COLLARED STEM 11 X 150 PROSTHESIS, HIP JDI BIOMET ORTHOPEDICS N/A 483820

    Patients

    Seq Age Sex Outcome Treatment
    1 18 YR Required Intervention