MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS, INC. 1818910 6IN AML SM STATURE 10.5MM; HIP FEMORAL STEM/SLEEVE

Catalog Number	155401106
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Nerve Damage (1979)
Date of Event	08/13/2017
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Event or Problem Description
Der states that patient had sciatic palsy after original surgery, possibly due to manipulation during original surgery.The surgeon plans to shorten the neck length hoping that sciatic nerve will regenerate.Update 8-25-2017: medical records have been reviewed.Progress notes (b)(6) 2017 indicate the patient is suffering from osteoarthritis from left hip dysplasia, congenital dysplasia.Reportability remains the same.Updated 9-11-2017.
Additional Manufacturer Narrative
No device associated with this report was received for examination.The information received will be retained for potential series investigations if triggered by trend analysis, post market surveillance, or other events within the quality system.Depuy considers the investigation closed.Should additional information be received, the information will be reviewed and the investigation will be re-opened as necessary.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

• Brand Name: 6IN AML SM STATURE 10.5MM
• Common Device Name: HIP FEMORAL STEM/SLEEVE
• Manufacturer (Section D): DEPUY ORTHOPAEDICS, INC. 1818910; 700 orthopaedic drive; warsaw IN 46582
• MDR Report Key: 6855571
• Report Number: 1818910-2017-24440
• Device Sequence Number: 19022898
• Product Code: LPH
• UDI-Device Identifier: 10603295058212
• UDI-Public: 10603295058212
• Combination Product (Y/N): N
• Initial Reporter State: MD
• Initial Reporter Country: US
• PMA/510(K) Number: K061833
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: company representative,consum
• Initial Reporter Occupation: Health Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/13/2017

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: 155401106
• Device Lot Number: H58972
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 08/13/2017
• Supplement Date Received by Manufacturer: 10/05/2017
• Initial Report FDA Received Date: 09/11/2017
• Supplement Report FDA Received Date: 10/11/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 41 YR