MAUDE Adverse Event Report: MICROPORT ORTHOPEDICS INC. COCR FEMORAL HEAD 28MM SLT TAPER +0MM NECK; HIP COMPONENT

Model Number 26012802

Device Problem Loss of Osseointegration (2408)

Patient Problem No Information (3190)

Event Type  Injury  

Event Description

Allegedly, revised due to total aseptic loosening.

• Brand Name: COCR FEMORAL HEAD 28MM SLT TAPER +0MM NECK
• 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: 10072228
• MDR Text Key: 191468683
• Report Number: 3010536692-2020-00364
• Device Sequence Number: 1
• Product Code: LPH
• UDI-Device Identifier: M684260128021
• UDI-Public: M684260128021
• Combination Product (y/n): N
• PMA/PMN Number: K932222
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: other
• Type of Report: Initial
• Report Date: 05/19/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/19/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 26012802
• Device Catalogue Number: 26012802
• Device Lot Number: 1477146
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Distributor Facility Aware Date: 07/02/2019
• Date Manufacturer Received: 07/02/2019
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Type of Device Usage: N
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 85 YR