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 Bone Fracture(s) (1870)

Event Date 11/22/2023

Event Type  Injury  

Event Description

Revision surgery - due to fracture.

Manufacturer Narrative

Complaint has been evaluated and is similar to previous report number 1644408-2021-00369; 425-97-009, s800 - revision surgery.If additional information regarding the reported event is submitted at a future date, this investigation will be re-evaluated.Both d-tickets were not provided and a search of djo records produced no results, therefore, the items could not be verified.

• 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: 18361419
• MDR Text Key: 330931878
• Report Number: 1644408-2023-01840
• 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: 12/19/2023

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: Health Professional
• Device Catalogue Number: 425-97-010
• Device Lot Number: 175R2356
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 11/22/2023
• Initial Date FDA Received: 12/19/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 02/28/2023
• 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: 400-03-362 LOT: 866B1986
• Patient Outcome(s): Required Intervention
• Patient Age: 81 YR
• Patient Sex: Female