FDA Adverse Event Injury Summary report: N

PINNACLE SECTOR II CUP 56MM

MDR report key: 7694778 · Received July 17, 2018

Report

Report Number
1818910-2018-64593
Event Type
Injury
Date Received
July 17, 2018
Date of Event
December 5, 2006
Report Date
June 21, 2018
Manufacturer
DEPUY ORTHOPAEDIC INC, 1818910
Product Code
LPH
UDI-DI
10603295009849
PMA / PMN Number
K000306
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
MS, US
Reporter Occupation
OTHER CAREGIVERS

Narratives

Additional Manufacturer Narrative · 1

PC-(B)(4).NO DEVICE ASSOCIATED WITH THIS REPORT WAS RECEIVED FOR EXAMINATION. THE INFORMATION RECEIVED WILL BE RETAINED FOR POTENTIAL SERIES INVESTIGATIONS IF TRIGGERED BY TREND ANALYSIS, POST MARKET SURVEILLANCE, OR OTHER EVENTS WITHIN THE QUALITY SYSTEM. DEPUY CONSIDERS THE INVESTIGATION CLOSED. SHOULD ADDITIONAL INFORMATION BE RECEIVED, THE INFORMATION WILL BE REVIEWED AND THE INVESTIGATION WILL BE RE-OPENED AS NECESSARY. IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE.

Additional Manufacturer Narrative · 1

(B)(4). IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE.

Description of Event or Problem · 1

COMPLAINT DESCRIPTION: LITIGATION ALLEGES THE PATIENT SUFFERS FROM PAIN, DISCOMFORT, IMMOBILITY, INFLAMMATION AND HIGH LEVELS OF CHROMIUM AND COBALT. UPDATE AD MAY 29, 2018: B)(4) HAS BEEN RE-OPENED UNDER (B)(4) DUE TO THE RECEIPT OF PPF AND STICKER SHEETS RECORD. PPF ALLEGES INFECTION REQUIRING IV ANTIBIOTICS AND LOOSENING OF STEM. UPDATED PRODUCT AND LOT NUMBER OF INSERT (121887356/2136865), HEAD ( 136531000/2193018), STEM ( 523422/2160316), CUP (121722056/A5WFX1000).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
535951 PINNACLE SECTOR II CUP 56MM PINNACLE HIP SYSTEM : HIP METAL ACETABULAR CUPS LPH DEPUY ORTHOPAEDIC INC, 1818910 A5WFX1000 10603295009849

Patients

Seq Age Sex Outcome Treatment
1 56 YR Other