BEUDAMED
    FDA Adverse Event Injury Summary report: N

    28MM STD V40 TAPER VIT HEAD

    MDR report key: 1113182 · Received August 12, 2008

    Report

    Report Number
    9616680-2008-00239
    Event Type
    Injury
    Date Received
    August 12, 2008
    Date of Event
    July 24, 2008
    Report Date
    July 24, 2008
    Manufacturer
    STRYKER ORTHOPAEDICS CORK
    Product Code
    KWY
    PMA / PMN Number
    K022077
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    NI

    Description of Event or Problem · 1

    IT WAS REPORTED FROM THE COVENANT HEALTHCARE EMERGENCY CARE CENTER REPORT DATED 2006, IT APPEARS THAT THE PATIENT WAS BROUGHT VIA AMBULANCE TO THE EMERGENCY ROOM WITH A DISLOCATED RIGHT HIP. ATTEMPT AT CLOSED REDUCTION WAS UNSUCCESSFUL AND THE PATIENT WAS REVISED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 28MM STD V40 TAPER VIT HEAD IMPLANT KWY STRYKER ORTHOPAEDICS CORK NA 17636701

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Required Intervention