MAUDE Adverse Event Report: ENCORE MEDICAL L.P TAPERFILL HIP STEM, LATERAL OFFSET, SIZE 10; PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, POROUS UNCEMENTED

Catalog Number 425-97-010

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Limb Fracture (4518)

Event Date 03/29/2024

Event Type  Injury  

Event Description

Revision surgery - due to fall lower body component and fracture.

Manufacturer Narrative

Complaint has been evaluated and is similar to previous report number 1644408-2019-01262; 425-97-010, s809 - trauma, revision surgery.If additional information regarding the reported event is submitted at a future date, this investigation will be re-evaluated.

• Brand Name: TAPERFILL HIP STEM, LATERAL OFFSET, SIZE 10
• Type of Device: PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, POROUS UNCEMENTED
• Manufacturer (Section D): ENCORE MEDICAL L.P; 9800 metric blvd; austin TX 78758
• Manufacturer (Section G): ENCORE MEDICAL L.P; 9800 metric blvd; austin TX 78758
• Manufacturer Contact: james mcmahon ; 9800 metric blvd; austin, TX 78758
• MDR Report Key: 19218428
• MDR Text Key: 341456694
• Report Number: 1644408-2024-00561
• Device Sequence Number: 1
• Product Code: LPH
• UDI-Device Identifier: 00888912078689
• UDI-Public: 00888912078689
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K130099
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date: 04/26/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/30/2024
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Catalogue Number: 425-97-010
• Device Lot Number: 175R2437
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 03/29/2024
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 01/16/2024
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Treatment: 400-03-363 LOT: 868B1577
• Patient Outcome(s): Required Intervention; Hospitalization
• Patient Age: 82 YR
• Patient Sex: Female