FDA Adverse Event Other Summary report: N

FEMORAL HEAD COMPONENTS

MDR report key: 1172656 · Received September 15, 2008

Report

Report Number
1644408-2008-00318
Event Type
Other
Date Received
September 15, 2008
Date of Event
August 27, 2008
Report Date
August 28, 2008
Manufacturer
ENCORE MEDICAL, L.P.
Product Code
KWY
PMA / PMN Number
K973302
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
IA, US
Reporter Occupation
NOT APPLICABLE

Narratives

Description of Event or Problem · 1

REVISION SURGERY - REPEATED DISLOCATIONS. THE PT WAS NON-COMPLIANT IN DAILY ACTIVITIES AND RECENTLY WAS REVISED TO A COSTRAINED LINER BY A DIFFERENT SURGEON.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 FEMORAL HEAD COMPONENTS HEAD, M-M FEM. 28/3.5MM KWY ENCORE MEDICAL, L.P. 53797683

Patients

Seq Age Sex Outcome Treatment
1 88 YR Required Intervention 433-28-205