BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SELF CENT HIP 50X28 BRN

    MDR report key: 1021326 · Received March 28, 2008

    Report

    Report Number
    1818910-2008-00987
    Event Type
    Injury
    Date Received
    March 28, 2008
    Date of Event
    March 8, 2008
    Report Date
    March 8, 2008
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    KWY
    PMA / PMN Number
    K812672
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report

    Narratives

    Additional Manufacturer Narrative · 1

    EXAMINATION WAS NOT POSSIBLE, AS THE DEVICE WAS NOT RETURNED. A COMPLAINT DATABASE SEARCH FINDS NO OTHER REPORTED INCIDENTS AGAINST THE PROVIDED PRODUCT AND LOT CODE SINCE ITS RELEASE FOR DISTRIBUTION. THE INVESTIGATION COULD NOT VERIFY OR IDENTIFY ANY EVIDENCE OF PRODUCT ERROR WITH REGARD TO THE REPORTED EVENT. BASED ON THE INVESTIGATION, THE NEED FOR CORRECTIVE ACTION IS NOT INDICATED. DEPUY CONSIDERS THIS INVESTIGATION CLOSED. SHOULD THE PRODUCT OR ADDITIONAL INFO THAT CHANGES THIS CONCLUSION BE RECEIVED, THE INVESTIGATION WILL BE REOPENED.

    Description of Event or Problem · 1

    PT REVISED TO ADDRESS DISLOCATION BETWEEN OUR HEAD AND PT'S ACETABULAR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SELF CENT HIP 50X28 BRN 87KWY KWY DEPUY ORTHOPAEDICS, INC. NA B5WGP1000

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR Required Intervention