MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,08 report with the FDA on 2014-09-22 for PFC C/R FEM POR LFT SZ4 864107 manufactured by Depuy-raynham, A Div. Of Depuy Orthopaedics 12196.
[4836367]
Patient was revised to address femoral loosening. Disassociation of the insert and tray was also reported.
Patient Sequence No: 1, Text Type: D, B5
[12174243]
This complaint is still under investigation. Depuy will notify the fda of the results of this investigation once it has been completed. If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10
[12572402]
Additional narrative: the device associated with this report was not returned. A complaint database search finds no other reported incidents against the provided product and lot combination. Requests for additional investigational inputs were made in accordance with wi-7915 appendix a. No additional information was obtained. The investigation could not verify or identify any product contribution to the reported event with the information provided. Based on the inability to identify root cause, the need for corrective action was not indicated. Depuy considers the investigation closed at this time. Should the additional information be received, the information will be reviewed and the investigation will be re-opened as necessary.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1818910-2014-28551 |
| MDR Report Key | 4107108 |
| Report Source | 05,08 |
| Date Received | 2014-09-22 |
| Date of Report | 2014-09-16 |
| Date of Event | 2014-09-16 |
| Date Mfgr Received | 2014-11-18 |
| Device Manufacturer Date | 1995-05-12 |
| Date Added to Maude | 2014-09-22 |
| 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 | STEVE DOWELL |
| Manufacturer Street | 700 ORTHOPAEDIC DRIVE |
| Manufacturer City | WARSAW IN 46581 |
| Manufacturer Country | US |
| Manufacturer Postal | 46581 |
| Manufacturer Phone | 5743714918 |
| Manufacturer G1 | DEPUY-RAYNHAM, A DIV. OF DEPUY ORTHOPAEDICS 12196 |
| Manufacturer Street | 325 PARAMOUNT DRIVE |
| Manufacturer City | RAYNHAM MA 02767 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 02767 |
| Single Use | 0 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PFC C/R FEM POR LFT SZ4 |
| Generic Name | KNEE FEMORAL COMPONENT |
| Product Code | HSA |
| Date Received | 2014-09-22 |
| Catalog Number | 864107 |
| Lot Number | 010819 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DEPUY-RAYNHAM, A DIV. OF DEPUY ORTHOPAEDICS 12196 |
| Manufacturer Address | 325 PARAMOUNT DRIVE RAYNHAM MA 02767 US 02767 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2014-09-22 |