MAUDE Adverse Event Report: STRYKER ORTHOPAEDICS-MAHWAH TRIDENT 10 DEG X3 INSERT 32MM ID; PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, POROUS UNCEMENTED

Model Number	723-10-32D
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	09/22/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Review of the device history records indicate devices were manufactured and accepted into final stock with no relevant reported discrepancies.There have been no other similar events for the lot referenced.It was noted that the device is not available for evaluation.Should additional information become available, it will be provided in a supplemental report upon completion of the investigation.The following devices were also listed in this report: delta v-40 ceramic head 32/0; cat # 6570-0-132; lot # 86198505.Tridentii tritanium cluster48d; cat # 702-04-48d; lot # 84107501a.6.5mm low profile hex screw 20mm; cat # 7030-6520; lot # yssj.6.5mm low profile hex screw 20mm; cat # 7030-6525; lot # yl6a3.6.5mm low profile hex screw 20mm; cat # 7030-6535; lot # 2lwh.6.5mm low profile hex screw 20mm; cat # 7030-6520; lot # yue.Size 3 accolade ii 127 deg; cat # 6721-0330; lot # 79371504.It cannot be determined which, if any of these devices may have caused or contributed to the patient's experience.
Event or Problem Description
As reported: "patient revised head and liner due to possible infection.Right hip.No other information available due to the hospital policy." spoke to rep, who supplied the primary and revision usage.No release of explants, and no further information due to hospital policy.

• Brand Name: TRIDENT 10 DEG X3 INSERT 32MM ID
• Common Device Name: PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, POROUS UNCEMENTED
• Manufacturer (Section D): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• MDR Report Key: 12646486
• Report Number: 0002249697-2021-01715
• Device Sequence Number: 1239874
• Product Code: LPH
• UDI-Device Identifier: 07613327339383
• UDI-Public: 07613327339383
• Combination Product (Y/N): N
• Initial Reporter State: IN
• Initial Reporter Country: US
• PMA/510(K) Number: K182468
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Device Explanted Year: 2021
• Reporter Type: Manufacturer
• Report Source: health professional,other
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 10/18/2021

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
• Operator of Device: Health Professional
• Device Expiration Date: 04/30/2026
• Device Model Number: 723-10-32D
• Device Catalogue Number: 723-10-32D
• Device Lot Number: KR56N4
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 09/22/2021
• Initial Report FDA Received Date: 10/18/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 52 YR