MAUDE MDR 5102895

MDR report key
5102895
Report number
0001825034-2015-04058
Event key
0
Event type
3
Date received
2015-09-24
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MS. MEGAN HAAS
Address
56 E. BELL DRIVE WARSAW IN 46582 US
Phone
574-574-5743
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1G7 NEUTRAL E1 LINER 32MM CPROSTHESIS, HIPBIOMET ORTHOPEDICSLKDN/A0100008473117782R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-09-2401. R

Event Narratives#

N

Patient 1

CURRENT INFORMATION IS INSUFFICIENT TO PERMIT A CONCLUSION AS TO THE CAUSE OF THE EVENT. THERE ARE WARNINGS IN THE PACKAGE INSERT THAT STATE THAT THIS TYPE OF EVENT CAN OCCUR: UNDER POSSIBLE ADVERSE EFFECTS, NUMBER 2 STATES, ?EARLY OR LATE POSTOPERATIVE INFECTION AND ALLERGIC REACTION.? NUMBER 8 STATES, "DISLOCATION AND SUBLUXATION DUE TO INADEQUATE FIXATION, MALALIGNMENT, MALPOSITION, EXCESSIVE, UNUSUAL AND/OR AWKWARD MOVEMENT AND/OR ACTIVITY, TRAUMA, WEIGHT GAIN, OR OBESITY." THIS REPORT IS NUMBER 2 OF 2 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2014-07690).

D

Patient 1

IT WAS REPORTED A PATIENT ENROLLED IN A CLINICAL STUDY UNDERWENT TOTAL LEFT HIP ARTHROPLASTY ON (B)(6) 2014. SUBSEQUENTLY, THE PATIENT EXPERIENCED DISLOCATION AND A SUPERFICIAL INFECTION; HOWEVER, NO REVISION PROCEDURE HAS BEEN REPORTED TO DATE.

N

Patient 1

THIS FOLLOW-UP REPORT IS BEING FILED TO RELAY ADDITIONAL INFORMATION, WHICH WAS UNKNOWN AT THE TIME OF THE INITIAL MEDWATCH.

N

Patient 1

THIS FOLLOW-UP REPORT IS BEING FILED TO RELAY ADDITIONAL INFORMATION, WHICH WAS UNKNOWN AT THE TIME OF THE INITIAL MEDWATCH. 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 2 STATES, ?EARLY OR LATE POSTOPERATIVE INFECTION AND ALLERGIC REACTION.? NUMBER 8 STATES, "DISLOCATION AND SUBLUXATION DUE TO INADEQUATE FIXATION, MALALIGNMENT, MALPOSITION, EXCESSIVE, UNUSUAL AND/OR AWKWARD MOVEMENT AND/OR ACTIVITY, TRAUMA, WEIGHT GAIN, OR OBESITY."