BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LPS CEMENTED STEM 14X125MM STR

    MDR report key: 1153290 · Received September 4, 2008

    Report

    Report Number
    1818910-2008-03854
    Event Type
    Injury
    Date Received
    September 4, 2008
    Date of Event
    August 5, 2008
    Report Date
    August 5, 2008
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    JWH
    PMA / PMN Number
    K033959
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, 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

    THE PT WAS REVISED BECAUSE THE FEMORAL COMPONENTS DISASSOCIATED FROM THE STEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LPS CEMENTED STEM 14X125MM STR 87JWH; 87JDI JWH DEPUY ORTHOPAEDICS, INC. NA VK2J11001

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR Required Intervention