BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DEPUY CAPTURED HIP SCREW SIDE PLATE

    MDR report key: 111072 · Received August 4, 1997

    Report

    Report Number
    2020311-1997-00020
    Event Type
    Malfunction
    Date Received
    August 4, 1997
    Date of Event
    March 21, 1997
    Report Date
    May 15, 1997
    Manufacturer
    DEPUY ACE MEDICAL CO.
    Product Code
    KTT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ON 3/21/1997, AN ACE CAPTURED HIP SCREW SYS WAS IMPLANTED IN A 300 LB., 85 YR. OLD FEMALE. ON 03/21/1997, THE SIDE PLATE BROKE AND WAS REMOVED ON 03/22/1997.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DEPUY CAPTURED HIP SCREW SIDE PLATE Implant INTERNA; HIP FIXATION KTT DEPUY ACE MEDICAL CO. NA QW2847

    Patients

    Seq Age Sex Outcome Treatment
    1 85 YR