MAUDE Adverse Event Report: ENCORE MEDICAL LP DJO SURGICAL; HEAD, FEMORAL, COCR 36MM

Model Number	497-36-000
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Joint Dislocation (2374)
Date of Event	02/17/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
This patient had a total hip on 6/26/2014.The patient sustained a fall yesterday and dislocated the hip.Dr.Yacoubian was not able to do a closed reduction and needed to do an open reduction.He elected to removed the 36id mp8 10 deg liner, 36 metal head and -3.5 sleeve and replace them with a mp8 40id 10 degree liner, 40 metal head and -3.5 sleeve.
Additional Manufacturer Narrative
Complaint has been evaluated and is similar to report number cc-00341521_1644408-2021-00742; 497-36-000, s809 - trauma, s803 - dislocation, revision surgery.If additional information regarding the reported event is submitted at a future date, this investigation will be re-evaluated.

• Brand Name: DJO SURGICAL
• Common Device Name: HEAD, FEMORAL, COCR 36MM
• Manufacturer (Section D): ENCORE MEDICAL LP; 9800 metric blvd.; austin TX 78758
• Manufacturer (Section G): ENCORE MEDICAL LP; 9800 metric blvd.; austin TX 78758
• Manufacturer Contact: stacey bonnell ; 9800 metric blvd.; austin, TX 78758 ; 8003219549
• MDR Report Key: 24622300
• Report Number: 1644408-2026-00422
• Device Sequence Number: 9833899
• Product Code: JDI
• UDI-Device Identifier: 00888912024051
• UDI-Public: 00888912024051
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K932481
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2014
• Device Explanted Year: 2026
• 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): 03/17/2026

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
• Operator of Device: Health Professional
• Device Expiration Date: 04/28/2020
• Device Model Number: 497-36-000
• Device Lot Number: 638C1112
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/17/2026
• Initial Report FDA Received Date: 03/17/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 05/02/2014
• 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: 411-00-035 903B1121; 931-36-254 692F1093
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 78 YR
• Patient Sex: Male