MAUDE Adverse Event Report: LIMACORPORATE S.P.A MODULAR HEADS; MODULAR FEMORAL HEADS (COCRMO) DIA. 36MM M TAPER 12/14

Model Number	5010.09.362
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Implant Pain (4561)
Date of Event	09/08/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery was performed on (b)(6) 2025 due to hip pain for unknown reason.Previous surgery is unknown, as well as complete original implant information.During revision the surgeon explanted the delta acetabular cup (part number 5553.14.482) and replaced the existing femoral head with a new one (femoral head cocrmo dia36mm medium, part number 5010.09.362).No information regarding new acetabular implant were provided.Surgery was completed as intended.The patient is female, date of birth (b)(6) 1974.The event occurred in the united states.
Additional Manufacturer Narrative
Explanted components have been discarded therefore cannot be returned to manufacturer for identification and analysis.No review of manufacturing records for complained parts can be performed either since lot number is unknown.No x-rays nor pictures of explanted components were provided either.From follow-up communication with complaint source it was confirmed that no further information regarding the case can be retrieved, therefore no further root cause investigation is possible.Taking into account the involved product family modular heads, no adverse trend has been identified for reported issue in the last year.According to investigation carried out, no corrective action is needed for this event.The manufacturer will continue monitoring the market in order to detect any similar event.

• Brand Name: MODULAR HEADS
• Common Device Name: MODULAR FEMORAL HEADS (COCRMO) DIA. 36MM M TAPER 12/14
• Manufacturer (Section D): LIMACORPORATE S.P.A; via nazionale 52; villanova di san daniele, udine 33038 ; IT 33038
• Manufacturer Contact: via nazionale 52; villanova di san daniele, udine 33038
• MDR Report Key: 24159390
• Report Number: 3008021110-2026-00025
• Device Sequence Number: 21082901
• Product Code: LPH
• UDI-Device Identifier: 08033390006910
• UDI-Public: 8033390006910
• Combination Product (Y/N): N
• PMA/510(K) Number: K112158
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 01/23/2026

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
• Device Model Number: 5010.09.362
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 01/23/2026
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown