inforMED
InjuryJDJ

TITANIUM ROOF PILE SCREW 40MM

Received Jun 17, 2022 · Event occurred Aug 6, 2009

Report 1818910-2022-11113 · MDR key 14732248

Device

Generic name

Bone Screws And Pins : Screws

Model number

1011-05-501

Catalog number

101105501

Lot number

B4ABD4000

Product problems

  • Adverse Event Without Identified Device or Use Problem
  • Adverse Event Without Identified Device or Use Problem

Patient

54 YR · Female

  • Adhesion(s)
  • Unspecified Infection
  • Scar Tissue
  • Adhesion(s)
  • Unspecified Infection
  • Scar Tissue

Narrative

Description of Event or Problem

PC WAS CREATED TO CAPTURE THE EVENT. ((B)(6)) (B)(6) 2009 OPERATIVE RECORDS INDICATE THE PATIENT RECEIVED A LEFT TOTAL HIP REVISION DUE TO SIGNIFICANT SCARRING AND GROSS INFECTION. ACETABULAR CAGE AND PROSTALAC WAS REMOVED AND IRRIGATION AND DEBRIDEMENT WAS PERFORMED. DOI: (B)(6) 2009. DOR: (B)(6) 2009. LEFT HIP.

Additional Manufacturer Narrative

PRODUCT COMPLAINT # (B)(4). INITIAL REPORTER OCCUPATION: LAWYER. 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. IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE.

Additional Manufacturer Narrative

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. DEVICE HISTORY LOT : THE PRODUCT INVESTIGATION FOUND NO EVIDENCE SUSPECTING AN ERROR IN THE MANUFACTURING OR MATERIAL THAT WOULD BE A CONTRIBUTING FACTOR IN THE REPORTED ALLEGATION(S). A MANUFACTURING RECORDS EVALUATION (MRE) WAS NOT PERFORMED.