BEUDAMED
    FDA Adverse Event Other Summary report: N

    ENCORE MODULAR HIP SYSTEM

    MDR report key: 1552313 · Received December 3, 2009

    Report

    Report Number
    1644408-2009-00573
    Event Type
    Other
    Date Received
    December 3, 2009
    Date of Event
    November 9, 2009
    Report Date
    November 9, 2009
    Manufacturer
    ENCORE MEDICAL, L.P.
    Product Code
    LPH
    PMA / PMN Number
    K955563
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SD, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY - PT HIP DISLOCATING, 28MM HEAD DISLOCATING FROM FMP LINER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENCORE MODULAR HIP SYSTEM FEMORAL HEAD, COCR LPH ENCORE MEDICAL, L.P. 275411

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Required Intervention 432-28-006/307771