MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer,other report with the FDA on 2020-03-31 for PINN LNR CON +4 10D 36IDX56OD 1218-36-756 121836756 manufactured by Depuy Orthopaedics Inc Us.
[186845121]
Product complaint # (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
[186845122]
Unf and medical records received. After review of the medical record, the patient was revised to address loosening of the stem, with proximal cement loosening but well fixed distally. Revision operative notes reported that the stem was grossly loose and there was significant torn polyethylene debris in the hip joint. Doi: (b)(6) 2016. Dor: (b)(6) 2017, right hip.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1818910-2020-09732 |
| MDR Report Key | 9903653 |
| Report Source | CONSUMER,OTHER |
| Date Received | 2020-03-31 |
| Date of Report | 2020-03-13 |
| Date of Event | 2017-08-11 |
| Date Mfgr Received | 2020-03-13 |
| Device Manufacturer Date | 2013-09-06 |
| Date Added to Maude | 2020-03-31 |
| 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 DR. |
| 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 | PINN LNR CON +4 10D 36IDX56OD |
| Generic Name | PINNACLE HIP SYSTEM : HIP CONSTRAINED ACETABULAR LINERS |
| Product Code | KWZ |
| Date Received | 2020-03-31 |
| Model Number | 1218-36-756 |
| Catalog Number | 121836756 |
| Lot Number | 422146 |
| Device Expiration Date | 2018-09-30 |
| 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 | 2020-03-31 |