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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US DLT TS CER HD 12/14 36MM +8.5; ARTICULEZE HEAD (12/14 TAPER) : HIP CERAMIC FEMORAL HEADS

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DEPUY ORTHOPAEDICS INC US DLT TS CER HD 12/14 36MM +8.5; ARTICULEZE HEAD (12/14 TAPER) : HIP CERAMIC FEMORAL HEADS Back to Search Results
Model Number 1365-36-730
Device Problems Device Dislodged or Dislocated (2923); Noise, Audible (3273)
Patient Problems Pain (1994); Joint Dislocation (2374); Ambulation Difficulties (2544); Test Result (2695); No Code Available (3191)
Event Date 12/19/2016
Event Type  Injury  
Manufacturer Narrative
If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.Device was used for treatment, not diagnosis.(b)(4).
 
Event Description
Ppf and sticker sheets received.Ppf alleges dislocation with closed reduction and elevated metal ions.After review of medical records, patient was revised to address recurrent dislocations.Doi: (b)(6) 2014 - dor: (b)(6) 2016 (right hip).
 
Manufacturer Narrative
Product complaint #: (b)(4).Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.Investigation summary: no device associated with this report was received for examination.A worldwide complaint database search found no other related reported incidents against the provided product code/lot number combination since release for distribution.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.Device history lot: null.Device history batch: null.Device history review: null.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
 
Manufacturer Narrative
Product complaint # (b)(4).Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees caused or contributed to the potential event described in this report.H10 additional narrative: added: b5 and h6 no code available use for device revision or replacement.
 
Event Description
Pfs alleges pain, walking difficulty and clunking after first revision.There were no revision notes reported.Doi: (b)(6) 2014 dor: (b)(6) 2016 right hip.
 
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Brand Name
DLT TS CER HD 12/14 36MM +8.5
Type of Device
ARTICULEZE HEAD (12/14 TAPER) : HIP CERAMIC FEMORAL HEADS
Manufacturer (Section D)
DEPUY ORTHOPAEDICS INC US
700 orthopaedic drive
warsaw IN 46582 0988
MDR Report Key8381543
MDR Text Key137514132
Report Number1818910-2019-86125
Device Sequence Number1
Product Code LZO
UDI-Device Identifier10603295033677
UDI-Public10603295033677
Combination Product (y/n)N
PMA/PMN Number
K071830
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type consumer,other
Type of Report Initial,Followup,Followup
Report Date 02/11/2019
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? Yes
Device Operator Health Professional
Device Expiration Date11/30/2018
Device Model Number1365-36-730
Device Catalogue Number136536730
Device Lot Number7826101
Was Device Available for Evaluation? No
Initial Date Manufacturer Received 02/11/2019
Initial Date FDA Received03/01/2019
Supplement Dates Manufacturer Received03/12/2019
03/08/2020
Supplement Dates FDA Received03/13/2019
03/23/2020
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
Patient Outcome(s) Other;
Patient Age62 YR
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