BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CORMET

    MDR report key: 6036261 · Received October 18, 2016

    Report

    Report Number
    9614209-2016-00154
    Event Type
    Injury
    Date Received
    October 18, 2016
    Date of Event
    July 14, 2016
    Report Date
    December 13, 2016
    Manufacturer
    CORIN MEDICAL
    Product Code
    NXT
    PMA / PMN Number
    P050016
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SZ
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    PER -5 INITIAL REPORT: THE APPROPRIATE DEVICE DETAILS HAVE BEEN PROVIDED AND THE RELEVANT DEVICE MANUFACTURING RECORDS HAVE BEEN IDENTIFIED AND REVIEWED. IT WAS FOUND THAT ALL PARTS ASSOCIATED WITH THESE RECORDS CONFORMED TO MATERIAL AND DIMENSIONAL SPECIFICATION. THE EXPLANTED DEVICES HAVE BEEN RETURNED TO CORIN FOR EXAMINATION. THE RESULTS OF THE EXAMINATION WILL BE PROVIDED IN A SUPPLEMENTAL REPORT UPON COMPLETION OF THE INVESTIGATION. PLEASE NOTE: THIS REPORT IS FILED WITH THE FDA DUE TO AN ADVERSE EVENT EXPERIENCED WITH A DEVICE THAT IS SIMILAR TO THOSE PLACED ON THE MARKET IN THE USA, HOWEVER, THIS EVENT OCCURRED OUTSIDE OF THE USA.

    Additional Manufacturer Narrative · 1

    PER -5 FINAL REPORT. THE APPROPRIATE DEVICE DETAILS HAVE BEEN PROVIDED AND THE RELEVANT DEVICE MANUFACTURING RECORDS HAVE BEEN IDENTIFIED AND REVIEWED. IT WAS FOUND THAT ALL PARTS ASSOCIATED WITH THESE RECORDS CONFORMED TO MATERIAL AND DIMENSIONAL SPECIFICATION WHEN MANUFACTURED. THE EXPLANTED DEVICES WERE RETURNED AND EXAMINED. THE EXAMINATION OF THE RETURNED EXPLANTS COULD NOT IDENTIFY A SPECIFIC REASON FOR REVISION OR ANY OBVIOUS FAILURE MODES OR ABNORMAL DEVICE CHARACTERISTICS. THE CORIN DEVICES WERE COUPLED WITH A TAPER CONVERSION SLEEVE (MANUFACTURER UNKNOWN), WHICH EXHIBITED EVIDENCE OF CORROSION INSIDE IT. BASED ON THIS, IT CANNOT BE DETERMINED WHETHER THE CORIN CORMET DEVICES CAUSED OR CONTRIBUTED TO THE PATIENTS EXPERIENCE AND CORIN NOW CONSIDER THIS CASE CLOSED. PLEASE NOTE: THIS REPORT IS FILED WITH THE FDA DUE TO AN ADVERSE EVENT EXPERIENCED WITH A DEVICE THAT IS PLACED ON THE MARKET IN THE USA, HOWEVER, THIS EVENT OCCURRED OUTSIDE OF THE USA.

    Description of Event or Problem · 1

    CORMET REVISION AFTER APPROXIMATELY 11 YEARS AND 8 MONTHS DUE TO METALLOSIS.

    Description of Event or Problem · 1

    CORMET REVISION AFTER APPROXIMATELY 11 YEARS AND 8 MONTHS DUE TO METALLOSIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    687669 CORMET RESURFACING HIP SYSTEM NXT CORIN MEDICAL 179.256B 015251

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R CORMET MODULAR HEAD E079.748, HWIF