FDA Adverse Event Injury Summary report: N

CORMET METAL ON METAL HIP RESURFACING

MDR report key: 1589820 · Received January 22, 2010

Report

Report Number
9614209-2009-00006
Event Type
Injury
Date Received
January 22, 2010
Date of Event
October 29, 2009
Report Date
November 4, 2009
Manufacturer
CORIN LTD
Product Code
KWY
PMA / PMN Number
P050016
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
VT, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

ADDITIONAL INFO HAS BEEN REQUESTED FROM THE REPORTING SITE. (B) (64).

Description of Event or Problem · 1

PT REVISED DUE TO POTENTIAL FEMORAL NECK FRACTURE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 CORMET METAL ON METAL HIP RESURFACING CORMET FEMORAL HEAD COMPONENT KWY CORIN LTD NOT KNOWN

Patients

Seq Age Sex Outcome Treatment
1 NA Hospitalization| R