| Brand Name | OXINIUM FEM HD 12/14 32MM +8 |
| Common Device Name | PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/CERAMIC/POLYMER, CEMENTED OR NON-POROUS |
| Manufacturer (Section D) |
| SMITH & NEPHEW, INC. |
| 1450 brooks rd. |
| memphis TN 38116 |
|
| Manufacturer (Section G) |
| SMITH & NEPHEW, INC. |
| 1450 brooks rd. |
|
| memphis TN 38116 |
|
| Manufacturer Contact |
|
holly
topping
|
| 1450 brooks rd. |
| memphis, TN 38116
|
|
5123913905
|
|
| MDR Report Key | 23876759 |
| Report Number | 1020279-2025-02104 |
| Device Sequence Number | 4671581 |
| Product Code |
LZO
|
| UDI-Device Identifier | 03596010474230 |
| UDI-Public | 3596010474230 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | CO |
| PMA/510(K) Number | K021673 |
| 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 |
Other,Foreign,Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
12/23/2025 |
| 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 | 71343208 |
| Device Lot Number | 19HM00940 |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 12/02/2025 |
| Initial Report FDA Received Date | 12/23/2025 |
| Date Device Manufactured | 08/01/2019 |
| 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 |
A
|
| Patient Sequence Number | 1 |
Concomitant Medical Products and Therapy/Usage Dates | PN: 71332515 / LOT: 24CM09846.; PN: 71332515 / LOT: 24KM06159.; PN: 71332530 / LOT: 25EM05296.; PN: 71332535 / LOT: 25FM01450.; PN: 71336520 / LOT: 19CB01304.; PN: 71337650 / LOT: 25DL00641.; PN: 71352350 / LOT: 25CM02163.; PN: 75100468 / LOT: D2509521. |
| Outcome Attributed to Adverse Event |
Required Intervention;
Hospitalization;
|
| Patient Age | 49 YR |
| Patient Sex | Unknown |
| Patient Weight | 85 KG |