BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEPUY HIP IMPLANT

    MDR report key: 8102062 · Received November 23, 2018

    Report

    Report Number
    MW5081597
    Event Type
    Injury
    Date Received
    November 23, 2018
    Date of Event
    October 22, 2018
    Report Date
    November 21, 2018
    Manufacturer
    DEPUY SYNTHES, INC.
    Product Code
    KWA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    THIS IS AN ONGOING PROBLEM CAUSED BY COBALT/CHROMIUM DEPUY HIP IMPLANT. IT DID NOT START ON A SPECIFIC DATE. METAL ON METAL HIP REPLACEMENT. I AM AN ACTIVE PERSON WALKING AND BIKE RIDING A COUPLE THOUSAND MILES PER YEAR, SO THERE IS A LOT OF METAL DEBRIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    938655 DEPUY HIP IMPLANT PROSTHESIS, HIP, SEMI-CONSTRAINED, (METAL UNCEMENTED ACETABULAR COMPONENT) KWA DEPUY SYNTHES, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Hospitalization| O| S