BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CORAIL2 LAT COXA VARA SIZE 12

    MDR report key: 4241987 · Received November 10, 2014

    Report

    Report Number
    1818910-2014-31490
    Event Type
    Injury
    Date Received
    November 10, 2014
    Date of Event
    June 2, 2009
    Report Date
    November 4, 2014
    Manufacturer
    DEPUY FRANCE SAS-3003895575
    Product Code
    KWA
    Removal / Correction Number
    Z-1749/1816-2011
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    DA
    Reporter Occupation
    PATIENT

    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. NO 510(K) NUMBER PROVIDED BECAUSE THIS IMPLANT IS SOLD INTERNATIONALLY WITH DIFFERENT INDICATIONS FOR USE; IT IS CURRENTLY SOLD IN THE US UNDER A DIFFERENT PART NUMBER. THE CORRECTION/REMOVAL REPORTING NUMBER LISTED APPLIES TO THE CORRESPONDING PRODUCT CODE SOLD DOMESTICALLY. 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 THE INVESTIGATION CLOSED AT THIS TIME. SHOULD THE PRODUCT AND/OR ADDITIONAL INFORMATION BE RECEIVED, THE INVESTIGATION WILL BE RE-OPENED.

    Description of Event or Problem · 1

    ASR REVISION, ASR XL- LEFT, REASON(S) FOR REVISION: PAIN. SURGEON UNKNOWN. UPDATE RECEIVED (B)(6) 2014. KID NUMBER ADDED, CHANGED TO LEGAL. MANUFACTURING DATES ADDED. COMMON NAME AND CONSTRUCT TYPE AMENDED FOR TAPER SLEEVE. UPDATE - ADDED SURGEON AND EXPIRY DATES. TAKEN FROM CLAIMSUITE DATED (B)(6) 2014. SURGEON - (B)(6). EXPIRY DATE : CUP - 15TH FEB 2012. HEAD - 27TH FEB 2012. STEM - 3RD SEPT 11. SLEEVE - 19TH FEB 2012.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    722662 CORAIL2 LAT COXA VARA SIZE 12 HIP FEMORAL STEM/SLEEVE KWA DEPUY FRANCE SAS-3003895575 2201211

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention