MAUDE Adverse Event Report: ENCORE MEDICAL L.P. TAPERFILL HIP; TAPERFILL HIP STEM, LATERAL OFFSET, SIZE 12

Model Number	425-97-012
Health Effect - Clinical Codes	Fall (1848); Bone Fracture(s) (1870)
Date of Event	07/07/2019
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery - the patient fell down and fractured her femur post-operation.
Additional Manufacturer Narrative
The reason for this revision surgery was reported as patient's fall.The previous surgery and the revision detailed in this investigation occurred 16 days apart.The healthcare professional indicated there was no delay in surgery and another suitable device was available for use.The revision surgery was completed as intended.Initial or prolonged hospitalization was required.The device was disposed of at the hospital and not made available to djo surgical for examination.A review of the implant device history records (dhr) shows that the reported components used in the previous surgery met design and manufacturing requirements.There were no nonconforming material reports (ncmr) associated with the products that may have contributed to the event.The device and its applicable concomitant device were within its respective expiration dates at the time of use during the previous surgery.Customer complaint history of the reported devices showed no present trends or on-going issues that are in need of review.The root cause of this complaint was a revision surgery due to patient's fall.There were no findings during this investigation that indicate that the reported device was the source or had a direct connection with the event.Agent has clearly mentioned that "the patient fell down and fractured her femur post operation." it seems that the event might have possibly occurred due to patient noncompliance with medical instructions, patient activities or trauma.Due to the short time between previous and revision surgery, it is also possible that the event may have been occurred due to excess load or lack of post-operative care.No additional information was submitted with the complaint regarding pre-existing conditions of the patient or any activities the patient was involved in that may have contributed to the event and hence a definitive root cause cannot be determined.There are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: TAPERFILL HIP
• Common Device Name: TAPERFILL HIP STEM, LATERAL OFFSET, SIZE 12
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd; austin texas 78758; austin, tx 78758-5445
• MDR Report Key: 8856132
• Report Number: 1644408-2019-00743
• Device Sequence Number: 2687916
• Product Code: LPH
• UDI-Device Identifier: 00888912078702
• UDI-Public: (01)00888912078702
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K130099
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Device Explanted Year: 2019
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/27/2019

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?: No
• Operator of Device: Health Professional
• Device Expiration Date: 04/01/2025
• Device Model Number: 425-97-012
• Device Catalogue Number: 425-97-012
• Device Lot Number: 177R2074
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 07/05/2019
• Supplement Date Received by Manufacturer: 07/31/2019
• Initial Report FDA Received Date: 08/02/2019
• Supplement Report FDA Received Date: 08/28/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: 400-03-322, LOT: 861B1151; 400-03-322, LOT: 861B1151
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 82 YR
• Patient Weight: 68