BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEPUY, INC

    MDR report key: 1083423 · Received July 18, 2008

    Report

    Report Number
    1083423
    Event Type
    Injury
    Date Received
    July 18, 2008
    Date of Event
    June 8, 2008
    Report Date
    June 25, 2008
    Manufacturer
    DEPUY, INC
    Product Code
    JDI
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    OK, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PT WAS ADMITTED FOR REVISION OF RIGHT TOTAL HIP, SECONDARY TO PAIN, REPEATED DISLOCATIONS & DECREASED RANGE OF MOTION. SENDING ALL DOCUMENTATION AVAILABLE ON 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, INC SEE ATTACHED JDI DEPUY, INC SEE ATTACHED SEE ATTACHED

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Hospitalization| R