MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2012-06-19 for M2A-TAPER LINER SZ 41/32 N/A 15-105004 manufactured by Biomet Orthopedics.
[2766953]
It was reported that patient underwent m2a hip arthroplasty on (b)(6), 2001. Subsequently, patient's surgeon plans on performing a revision procedure due to pain and metal sensitivity. No revision procedure has occurred to date.
Patient Sequence No: 1, Text Type: D, B5
[9922957]
Event date - no revision procedure has been scheduled to date. Explanted date - device remains implanted. Current information is insufficient to permit a conclusion as to the cause of the event. Review of device history records show that lot released with no recorded anomaly or deviation. There are warnings in the package insert that state that this type of event can occur: under possible adverse effects, number one states, "material sensitivity reactions". Number fourteen states, "postoperative bone fracture and pain". This report is number 4 of 4 mdrs filed for the same event (reference 1825034-2012-00851).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 0001825034-2012-00854 |
| MDR Report Key | 2620455 |
| Report Source | 07 |
| Date Received | 2012-06-19 |
| Date of Report | 2012-05-21 |
| Date Mfgr Received | 2012-05-21 |
| Device Manufacturer Date | 2001-08-22 |
| Date Added to Maude | 2012-06-19 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | MS. ANGELA DICKSON |
| Manufacturer Street | 56 E. BELL DRIVE |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal | 46582 |
| Manufacturer Phone | 5743711021 |
| Manufacturer G1 | BIOMET ORTHOPEDICS |
| Manufacturer Street | 56 E. BELL DRIVE |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 46582 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | N/A |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | M2A-TAPER LINER SZ 41/32 |
| Generic Name | PROSTHESIS, HIP |
| Product Code | BSN |
| Date Received | 2012-06-19 |
| Model Number | N/A |
| Catalog Number | 15-105004 |
| Lot Number | 017800 |
| ID Number | N/A |
| Device Expiration Date | 2011-08-31 |
| Operator | PHYSICIAN |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BIOMET ORTHOPEDICS |
| Manufacturer Address | 56 E. BELL DRIVE WARSAW IN 46582 US 46582 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2012-06-19 |