MAUDE Adverse Event Report: ENCORE MEDICAL L.P. DJO SURGICAL; TAPERFILL HIP STEM, LATERAL OFFSET, SIZE 8

Catalog Number	425-97-008
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Periprosthetic fracture (4902)
Date of Event	09/17/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Complaint has been evaluated and is similar to report number 1644408-2023-00080; 425-97-009, s800 - revision surgery, revision surgery.If additional information regarding the reported event is submitted at a future date, this investigation will be re-evaluated.
Event or Problem Description
Revision surgery - due to periprosthetic fracture.

• Brand Name: DJO SURGICAL
• Common Device Name: TAPERFILL HIP STEM, LATERAL OFFSET, SIZE 8
• 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: stacey bonnell ; 9800 metric blvd; austin, TX 78758 ; 5128346313
• MDR Report Key: 23273685
• Report Number: 1644408-2025-01464
• Device Sequence Number: 9757360
• Product Code: LPH
• UDI-Device Identifier: 00888912078665
• UDI-Public: 00888912078665
• Combination Product (Y/N): N
• Initial Reporter State: IA
• Initial Reporter Country: US
• PMA/510(K) Number: K130099
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2025
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 10/10/2025

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 Catalogue Number: 425-97-008
• Device Lot Number: 173R1453
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/18/2025
• Initial Report FDA Received Date: 10/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 04/21/2025
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: 400-03-362 LOT: 866B2330.; 940-00-035 LOT: 148Z1278.; 940-02-50E LOT:799Z1459.; 941-01-36E LOT: 597Z1366.
• Outcome Attributed to Adverse Event: Other; Required Intervention
• Patient Sex: Female