MAUDE Adverse Event Report: ENCORE MEDICAL L.P TAPERFILL HIP STEM, STANDARD, SIZE 5; PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, POROUS UNCEMENTED

Catalog Number 425-96-005

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

Patient Problem Joint Laxity (4526)

Event Date 03/05/2024

Event Type  Injury  

Manufacturer Narrative

Complaint has been evaluated and is similar to previous report number 1644408-2022-00566; 425-97-011, s810 - device loosening, revision surgery;surgical - quality complaints.If additional information regarding the reported event is submitted at a future date, this investigation will be re-evaluated.

Event Description

Revision surgery - due to loosening.

• Brand Name: TAPERFILL HIP STEM, STANDARD, SIZE 5
• 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: 19016783
• MDR Text Key: 339081139
• Report Number: 1644408-2024-00390
• Device Sequence Number: 1
• Product Code: LPH
• UDI-Device Identifier: 00888912078504
• UDI-Public: 00888912078504
• 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: 04/01/2024

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: 425-96-005
• Device Lot Number: 184R1145
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 03/05/2024
• Initial Date FDA Received: 04/01/2024
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 02/20/2023
• 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: 400-03-402 LOT: 871B1456
• Patient Outcome(s): Required Intervention
• Patient Age: 64 YR
• Patient Sex: Female