MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer,other report with the FDA on 2020-03-16 for TRI-LOCK TI 15.0 LAT OFFSET 101212150 manufactured by Depuy Orthopaedics Inc Us.
[188232073]
(b)(4). Initial reporter occupation: lawyer. (b)(4). 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
[188232075]
Pinnacle claim form and medical records received. After review of medical records, the patient was revised to address pain and elevated metal ion levels. Additionally, patient also experienced walking difficulty and inability to bear weight. Revision notes reported cloudy fluid within the pseudo tumor, corrosive changes in the trunnion, mild osteolysis in the proximal femur and acetabular cup in vertical orientation and a fair amount of anterversion. An mri of his hip shows an abnormal fluid collection around his right hip. Doi: (b)(6) 2005; dor: (b)(6) 2018; right hip.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1818910-2020-07930 |
| MDR Report Key | 9834540 |
| Report Source | CONSUMER,OTHER |
| Date Received | 2020-03-16 |
| Date of Report | 2020-02-26 |
| Date of Event | 2018-06-15 |
| Date Mfgr Received | 2020-02-26 |
| Device Manufacturer Date | 2005-08-09 |
| Date Added to Maude | 2020-03-16 |
| 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 | 3 |
| Event Location | 3 |
| Manufacturer Contact | KARA DITTY-BOVARD |
| Manufacturer Street | 700 ORTHOPAEDIC DRIVE |
| Manufacturer City | WARSAW IN 465810988 |
| Manufacturer Country | US |
| Manufacturer Postal | 465810988 |
| Manufacturer Phone | 6107428552 |
| Manufacturer G1 | DEPUY ORTHOPAEDICS, INC. 1818910 |
| Manufacturer Street | 700 ORTHOPAEDIC DR. |
| Manufacturer City | WARSAW IN 465810988 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 465810988 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | TRI-LOCK TI 15.0 LAT OFFSET |
| Generic Name | TRILOCK HIP STEM : HIP FEMORAL STEM |
| Product Code | KWL |
| Date Received | 2020-03-16 |
| Catalog Number | 101212150 |
| Lot Number | Z2PDA1000 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DEPUY ORTHOPAEDICS INC US |
| Manufacturer Address | 700 ORTHOPAEDIC DRIVE WARSAW IN 465810988 US 465810988 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2020-03-16 |