BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LCS 3 PEG ROT PATELLA CEM LG

    MDR report key: 1250722 · Received December 2, 2008

    Report

    Report Number
    1818910-2008-05563
    Event Type
    Injury
    Date Received
    December 2, 2008
    Report Date
    November 3, 2008
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    MBH
    PMA / PMN Number
    P830055
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, 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

    PATIENT REVISED TO ADDRESS OSTEOLYSIS, POLYETHYLENE WEAR AND LOOSE FEMORAL AND TIBIAL COMPONENTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LCS 3 PEG ROT PATELLA CEM LG 87MBH MBH DEPUY ORTHOPAEDICS, INC. NA WL4B91029

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Required Intervention