S-ROM

Description of Event or Problem

Patient was revised due to loosening of the sleeve and stem at the bone to implant interface. No delay. No harm to patient. No additional information is available.DOI: ON (b)(6) 2019,DOR: ON (b)(6) 2026,Affected side: Left hip.

Additional Manufacturer Narrative

PRODUCT COMPLAINT#: (b)(4).This report is being submitted pursuant to the provisions of 21 CFR, Part 803 (and/or Part 4, as applicable). This report may be based on information which has not been investigated or verified prior to the required reporting date. This report does not reflect a conclusion by DePuy Synthes, or its employees that the report constitutes an admission that the product, 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.D4: UDI: As the lot number for the device involved in the event was not provided, the full UDI is currently not available.INVESTIGATION SUMMARY:No device associated with this report was received for examination.An evaluation of the manufacturing record could not be performed as the required product/lot number was not provided to complete the evaluation. As part of our company quality system process, all devices are manufactured, inspected, and distributed to approved specifications.Additional complaint information monitoring for potential safety signals will be conducted through complaint trending as part of the post-market surveillance. If additional information is made available, the investigation will be updated as applicable.DEVICE HISTORY:The device lot number is unknown, therefore a¿Device History Review could not be performed.¿ If the lot/serial number becomes available, the record will be re-assessed.