FDA Adverse Event Injury Summary report: N

BIPOLAR ENDOPROSTHETIC HEAD

MDR report key: 5198 · Received April 27, 1993

Report

Report Number
5198
Event Type
Injury
Date Received
April 27, 1993
Date of Event
March 26, 1993
Report Date
April 6, 1993
Manufacturer
KIRSCHNER MEDICAL CORP.
Product Code
JDG
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

PATIENT WAS ORIGINALLY TREATED FOR COLLASPED FEMORAL HEAD WITH CEMENTLESS LEFT HIP REPLACEMENT IN MAY 1991. ON 3/26/93 PATIENT HAD REVISION OF LEFT TOTAL HIP ARTHROPLASTY (FEMORAL AND ACETABULAR COMPONENTS) DUE TO PAINFUL, FAILED LEFT HIP REPLACEMENT. CATALOG NUMBER TAG FOR KIRSCHNER BIPOLAR HEAD PLACED IN MEDICAL ARECORD DOES NOT MATCH CATALOG NUMBER ON DEVICE ITSELF. PATIENT WAS FOUND TO HAVE METAL DEBRIS IN HIP JOINT., CAUSED BY THE INNER HEAD OF THE BIPOLAR COMPONENT WEARING THROUGH THE POLYETHYLENE LINER AND COMING IN CONTACT CWITH THE OUTER METAL HEAD. DEVICE MAY BE SENT TO KIRSCHNER FOR EVALUATIONINVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE NOT SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. INVALID DATA - REGARDING WHETHER EVENT PRESENTS IMMINENT HAZARD. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, VISUAL EXAMINATION. RESULTS OF EVALUATION: TELEMETRY FAILURE, NONE OR UNKNOWN. CONCLUSION: NONE OR UNKNOWN. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: MAYBE. CORRECTIVE ACTIONS: DEVICE PERMANENTLY REMOVED FROM SERVICE. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 BIPOLAR ENDOPROSTHETIC HEAD Implant BIPLAR HEAD (PART OF PROSTHESIS, JOINT, HIP) JDG KIRSCHNER MEDICAL CORP. AEA

Patients

Seq Age Sex Outcome Treatment
1 45 YR Required Intervention