MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US HYLAMER 10D 62 OR 74ODX32ID; DURALOC IMPLANT : HIP POLY ACETABULAR LINERS

Catalog Number 125262000

Device Problem Naturally Worn (2988)

Patient Problem No Code Available (3191)

Event Date 12/13/2019

Event Type  Injury  

Manufacturer Narrative

(b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

Event Description

It was reported that the patient was being revised due to poly wear.The surgeon replaced locking ring and poly with a 36+4 10 degree and femoral head with a 36+3 14/16 taper.All other components were retained.Doi: unknown; dor: (b)(6) 2019; unknown affected side.

Manufacturer Narrative

Depuy synthes is submitting this report pursuant to the provision of 21 cfr, part 803.The report may be based on the 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.Product complaint # (b)(4).Investigation summary: 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: HYLAMER 10D 62 OR 74ODX32ID
• Type of Device: DURALOC IMPLANT : HIP POLY ACETABULAR LINERS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• MDR Report Key: 9557721
• MDR Text Key: 173935609
• Report Number: 1818910-2020-00802
• Device Sequence Number: 1
• Product Code: KWY
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Type of Report: Initial,Followup
• Report Date: 12/13/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/07/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: 125262000
• Device Lot Number: 552540
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 02/04/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: TOTAL HIP BALL 32MM +5; UNKNOWN HIP IMPLANT (LOCKING RING); TOTAL HIP BALL 32MM +5; UNKNOWN HIP IMPLANT (LOCKING RING)
• Patient Outcome(s): Required Intervention
• Patient Age: 81 YR
• Patient Weight: 89