MAUDE Adverse Event Report: ENCORE MEDICAL L.P. LINEAR HIP; LINEAR, STD, REDUCED NECK, SZ 7, W/P2 COATING

Model Number	425-98-007
Health Effect - Clinical Code	Fall (1848)
Date of Event	12/07/2019
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Additional reporting on this event will be provided as a supplemental report to this document as soon as it becomes available.
Event or Problem Description
Revision surgery, patient fell and subsided.
Additional Manufacturer Narrative
The reason for this revision surgery was reported as patient fell.The previous surgery and the surgery detailed in this event occurred 14 days apart.Initial or prolonged hospitalization was required.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.The device was disposed of at hospital and not made available to djo surgical for examination.A review of the device history record (dhr) show that the reported component used in the previous surgery, when released for use, met design and manufacturing requirements.There was an ncmr#: 51806 associated with the main part, which documents that out of 12 parts lot, 1 part was scrapped by vendor and other 3 parts were scrapped due to edge lifting.020 feeler gauge catches under lip and a bend can be produced which is unacceptable.The device was verified to have gone through an acceptable sterilization process and was within its expiration date at the time of the previous surgery.Customer complaint history of the reported devices showed no present trends or on-going issues that are needing a review.The root cause of this complaint was a revision surgery due to patient fell.There were no findings during this evaluation that indicate the reported device was defective.No 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.Agent has clearly mentioned that "patient fell and subsided" and due to short time between the previous and revision surgery, it seems that the event may possibly occurred due to patient noncompliance with medical instruction, improper implant selection, patient activities or trauma.There are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: LINEAR HIP
• Common Device Name: LINEAR, STD, REDUCED NECK, SZ 7, W/P2 COATING
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd; austin, tx 78758-5445,
• MDR Report Key: 9547428
• Report Number: 1644408-2019-01316
• Device Sequence Number: 2461214
• Product Code: LPH
• UDI-Device Identifier: 00888912078795
• UDI-Public: (01)00888912078795
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K120241
• 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): 02/18/2020

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: 10/03/2025
• Device Model Number: 425-98-007
• Device Catalogue Number: 425-98-007
• Device Lot Number: 559G1097
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 12/07/2019
• Supplement Date Received by Manufacturer: 01/20/2020
• Initial Report FDA Received Date: 01/03/2020
• Supplement Report FDA Received Date: 02/18/2020
• 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: Hospitalization; Required Intervention
• Patient Age: 89 YR