BEUDAMED
    FDA Adverse Event Other Summary report: N

    NONE

    MDR report key: 1474620 · Received August 24, 2009

    Report

    Report Number
    1644408-2009-00421
    Event Type
    Other
    Date Received
    August 24, 2009
    Date of Event
    July 16, 2009
    Report Date
    July 16, 2009
    Manufacturer
    ENCORE MEDICAL, L.P.
    Product Code
    JDH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ME, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY - HUMERAL MORSE TAPER DISSOCIATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NONE JDH ENCORE MEDICAL, L.P.

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Required Intervention