MAUDE Adverse Event Report: MEDACTA INTERNATIONAL SA VERSACEM ACETABULAR SHELL AND DOUBLE MOBILITY HC LINERS; DOUBLE MOBILITY HC LINER Ø28/DMC

Model Number	01.26.2846MHC
Medical Device Problem Code	Device Appears to Trigger Rejection (1524)
Health Effect - Clinical Code	Medical device site infection (4845)
Date of Event	02/28/2026
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Batch review performed on 11 mar 2026.Liner: versafitcup cc trio 01.26.2846mhc double mobility hc liner d 28/dmc (k241767) lot.2520044: (b)(4) items manufactured and released on 02 oct 2025.Expiration date: 2030-sept -09.No anomalies found related to the problem.To date, (b)(4) items of the same lot have been sold with no similar reported event during the period of review.Liner: versafitcup cc trio 01.32.3844cf dm converter e/dmc - tin coated (k211891)lot.2503248: (b)(4) items manufactured and released on 23 jul 2025.Expiration date: 2030-jul-07.No anomalies found related to the problem.To date, (b)(4) items of the same lot have been sold with no similar reported event during the period of review.Cup: versafitcup cc trio 01.26.45.0050 versafitcup metalback cc trio d 50 mm (k103352) lot.2500243: (b)(4) items manufactured and released on 24 mar 2025.Expiration date: 2030-march-03.No anomalies found related to the problem.To date, (b)(4) items of the same lot have been sold with no similar reported event during the period of review.Ball heads: cocr 01.25.014 cocr ball head 12/14 d 28 mm size xl (k072857) lot.2345673: (b)(4) items manufactured and released on 25 mar 2024.Expiration date: 2029-mar-07.No anomalies found related to the problem.To date, (b)(4) items of the same lot have been sold with no similar reported event during the period of review.Root cause: infection is a known possible complication of any surgery.Although no root cause can be established, there is no indication that any issue with the device may have caused or contributed to the event, and the document review does not indicate any potential manufacturing related cause.
Event or Problem Description
Revision surgery was performed approximately 10 days after the primary surgery due to an acute joint infection of unknown origin.The surgery was completed successfully.

• Brand Name: VERSACEM ACETABULAR SHELL AND DOUBLE MOBILITY HC LINERS
• Common Device Name: DOUBLE MOBILITY HC LINER Ø28/DMC
• Manufacturer (Section D): MEDACTA INTERNATIONAL SA; strada regina; castel san pietro 6874 ; SZ 6874
• Manufacturer Contact: marco giannessi ; strada regina; castel san pietro 6874 ; SZ 6874
• MDR Report Key: 24711032
• Report Number: 3005180920-2026-00250
• Device Sequence Number: 5677382
• Product Code: LZO
• UDI-Device Identifier: 07630542703928
• UDI-Public: 07630542703928
• Combination Product (Y/N): N
• PMA/510(K) Number: K241767
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2026
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 03/27/2026

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 Model Number: 01.26.2846MHC
• Device Lot Number: 2520044
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/28/2026
• Initial Report FDA Received Date: 03/30/2026
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/02/2025
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Female