BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN DEPUY METAGLENE SCREW

    MDR report key: 1080897 · Received July 22, 2008

    Report

    Report Number
    1818910-2008-02799
    Event Type
    Injury
    Date Received
    July 22, 2008
    Date of Event
    June 24, 2008
    Report Date
    June 24, 2008
    Manufacturer
    DEPUY FRANCE S.A.
    Product Code
    HSD
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THIS COMPLAINT IS STILL UNDER INVESTIGATION. DEPUY WILL NOTIFY THE FDA OF THE RESULTS OF THIS INVESTIGATION ONCE IT HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    PATIENT WAS REVISED TO ADDRESS GLENOID LOOSENING (RIGHT SIDE). ONE OF THE SCREWS WAS BROKEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN DEPUY METAGLENE SCREW TOTAL SHOULDER PROSTHESIS HSD DEPUY FRANCE S.A. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Required Intervention