MAUDE Adverse Event Report: DEPUY FRANCE SAS - 3003895575 CORAIL2 LAT COXA VARA SIZE 12; CORAIL AMT CEMENTLESS IMPLANT : HIP FEMORAL STEM

Model Number 3L93712

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

Patient Problems Atrial Fibrillation (1729); Foreign Body Reaction (1868); Rash (2033); Weakness (2145); Anxiety (2328); Discomfort (2330); Polydipsia (2604); No Code Available (3191)

Event Date 03/16/2011

Event Type  Injury  

Manufacturer Narrative

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.

Event Description

Litigation alleges that patient experienced pain, weakness, difficulty with simple daily living activities, inability to return to work, and increased metallic ions in his bloodstream.Revision operative note reviewed and confirmed metallosis.The revision operative note also mentions alval.In addition to what previously alleged, litigation alleged metal wear, skin rashes, weight loss, pain, increase incidence of atrial fibrillation, anxiety, thirst, loose of taste, metallic taste in saliva, and dry fragile skin.After review of medical records it was indicated that the patient present with progressive worsening left hip pain, demonstrated elevated metal ions.The patient was then revised for painful metal-sensitivity reaction to necrosis (alval).Operative notes reported that the cup was little generously anteverted and there was some erosive deficiency noted of the anterior acetabular bony wall, due to inflammatory process.

Manufacturer Narrative

Product complaint # (b)(4).Investigation summary no device associated with this report was received for examination.The information received will be retained for potential series investigations if triggered by trend analysis, post market surveillance, or other events within the quality system.Depuy considers the investigation closed.Should additional information be received, the information will be reviewed and the investigation will be re-opened as necessary.Device history lot the product investigation found no evidence suspecting an error in the manufacturing or material that would be a contributing factor in the reported allegation(s).A manufacturing records evaluation (mre) was not performed.

• Brand Name: CORAIL2 LAT COXA VARA SIZE 12
• Type of Device: CORAIL AMT CEMENTLESS IMPLANT : HIP FEMORAL STEM
• Manufacturer (Section D): DEPUY FRANCE SAS - 3003895575; 7 allee irene joliot-curie; b.p. 256; saint priest cedex 69801 ; FR 69801
• Manufacturer (Section G): DEPUY FRANCE SAS 3003895575; 7 allee irene joliot-curie; b.p. 256; saint priest cedex 69801 ; FR 69801
• Manufacturer Contact: kara ditty-bovard ; 700 orthopaedic dr.; b.p. 256; warsaw 46581 ; 6107428552
• MDR Report Key: 9899654
• MDR Text Key: 186276235
• Report Number: 1818910-2020-09613
• Device Sequence Number: 1
• Product Code: KWA
• UDI-Device Identifier: 10603295168898
• UDI-Public: 10603295168898
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K042992
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Consumer
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 05/23/2012

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 Expiration Date: 09/01/2013
• Device Model Number: 3L93712
• Device Catalogue Number: 3L93712
• Device Lot Number: 2743913
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 03/15/2020
• Initial Date FDA Received: 03/30/2020
• Supplement Dates Manufacturer Received: 02/18/2022
• Supplement Dates FDA Received: 02/20/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 10/31/2008
• 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
• Patient Outcome(s): Required Intervention
• Patient Age: 69 YR
• Patient Sex: Female
• Patient Weight: 48 KG