MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US PINN SECTOR W/GRIPTION 52MM; PINNACLE HIP SYSTEM : HIP METAL ACETABULAR CUPS

Model Number 1217-32-052

Device Problem Malposition of Device (2616)

Patient Problem No Code Available (3191)

Event Date 10/21/2020

Event Type  Injury  

Manufacturer Narrative

Product complaint # (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

It was reported that the doctor needed to medialize the cup.Doi: (b)(6) 2019, dor: (b)(6) 2020, affected side: left hip.

Manufacturer Narrative

Product complaint # (b)(4).Investigation summary = no device associated with this report was received for examination.Cup positioning is the responsibility of the implanting surgeon and is not considered a product problem.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: PINN SECTOR W/GRIPTION 52MM
• Type of Device: PINNACLE HIP SYSTEM : HIP METAL ACETABULAR CUPS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• MDR Report Key: 10828944
• MDR Text Key: 215902136
• Report Number: 1818910-2020-24412
• Device Sequence Number: 1
• Product Code: LPH
• UDI-Device Identifier: 10603295010302
• UDI-Public: 10603295010302
• Combination Product (y/n): N
• PMA/PMN Number: K071784
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Type of Report: Initial,Followup
• Report Date: 10/21/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/12/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 1217-32-052
• Device Catalogue Number: 121732052
• Device Lot Number: 9029334
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 12/03/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: ALTRX +4 10D 36IDX52OD; APEX HOLE ELIM POSITIVE STOP; ARTICULEZE M HEAD 36 MM -2; PINN CAN BONE SCREW 6.5 MMX25 MM; PINN CAN BONE SCREW 6.5 MMX25 MM; ALTRX +4 10D 36IDX52OD; APEX HOLE ELIM POSITIVE STOP; ARTICULEZE M HEAD 36 MM -2; PINN CAN BONE SCREW 6.5 MMX25 MM; PINN CAN BONE SCREW 6.5 MMX25 MM
• Patient Outcome(s): Required Intervention
• Patient Age: 77 YR