BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASR UNI FEMORAL IMPL SIZE 53

    MDR report key: 4112390 · Received September 23, 2014

    Report

    Report Number
    1818910-2014-28721
    Event Type
    Injury
    Date Received
    September 23, 2014
    Date of Event
    September 4, 2014
    Report Date
    February 16, 2015
    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
    MI, US
    Reporter Occupation
    HEALTH PROFESSIONAL

    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. (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

    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

    UPDATE REC'D 02/16/2015- LITIGATION PAPERS RECEIVED. LITIGATION ALLEGES PAIN, GRINDING, CLICKING, POPPING, DIFFICULTY WALKING, INSTABILITY, INFECTION, DISABILITY, DISFIGUREMENT, AND ELEVATED METAL ION LEVELS. THE DOB WAS PROVIDED. THE STEM IS BEING ADDED TO THE COMPLAINT DUE TO ELEVATED METAL ION LEVELS BEING REPORTED. THE COMPLAINT WAS UPDATED ON: 02/24/2015.

    Description of Event or Problem · 1

    SALES REP REPORTED REVISION SURGERY. PATIENT HAS BEEN REVISED TO ADDRESS PAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    589834 ASR UNI FEMORAL IMPL SIZE 53 HIP FEMORAL HEAD KWA DEPUY INTL., LTD. - 8010379 2728558

    Patients

    Seq Age Sex Outcome Treatment
    1 89 YR Required Intervention