MAUDE Adverse Event Report: MICROPORT ORTHOPEDICS INC. DELTA OPTION HEAD - 32MM; HIP COMPONENT

Model Number PHA04432

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

Patient Problem Insufficient Information (4580)

Event Type  Injury  

Manufacturer Narrative

This event will be updated once the investigation is complete.Trends will be evaluated.

Event Description

Allegedly, patient has metal transcend liner in a lineage cup, and head revision.

Manufacturer Narrative

Additional information received on 02/28/2022 please void the following report.

• Brand Name: DELTA OPTION HEAD - 32MM
• Type of Device: HIP COMPONENT
• Manufacturer (Section D): MICROPORT ORTHOPEDICS INC.; 5677 airline rd.; arlington TN 38002
• Manufacturer (Section G): MICROPORT ORTHOPEDICS INC.; 5677 airline rd.; arlington TN 38002
• Manufacturer Contact: 5677 airline road; arlington, TN 38002 ; 9018674771
• MDR Report Key: 13122352
• MDR Text Key: 283079240
• Report Number: 3010536692-2021-00613
• Device Sequence Number: 1
• Product Code: LZO
• UDI-Device Identifier: M684PHA044321
• UDI-Public: M684PHA044321
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative,Distributor
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 02/28/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Other
• Device Model Number: PHA04432
• Device Catalogue Number: PHA04432
• Device Lot Number: 1767745
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Distributor Facility Aware Date: 12/13/2021
• Initial Date Manufacturer Received: 12/13/2021
• Initial Date FDA Received: 12/30/2021
• Supplement Dates Manufacturer Received: 12/13/2021
• Supplement Dates FDA Received: 02/28/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 62 YR
• Patient Sex: Male