BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEPUY

    MDR report key: 1032951 · Received April 11, 2008

    Report

    Report Number
    1032951
    Event Type
    Injury
    Date Received
    April 11, 2008
    Date of Event
    March 11, 2008
    Report Date
    March 19, 2008
    Manufacturer
    DEPUY INC
    Product Code
    KWB
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    OK, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT WAS ADMITTED FOR REVISION OF LEFT HIP, SECONDARY TO PAIN & INSTABILITY, FROM POSSIBLE LOOSE, WORN COMPONENTS. IN ACCORDANCE WITH HOSP POLICY, THE COMPONENTS REMOVED ARE NOT AVAILABLE FOR RELEASE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DEPUY HIP KWB DEPUY INC * *

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Hospitalization| R