BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CTM LCS PFC 3-PEG PAT SM+ ROT

    MDR report key: 1723002 · Received June 11, 2010

    Report

    Report Number
    1818910-2010-03729
    Event Type
    Injury
    Date Received
    June 11, 2010
    Date of Event
    May 14, 2010
    Report Date
    May 14, 2010
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    LXH
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, 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

    PT REVISED FOR CUSTOM PATELLAR BEARING DISASSOCIATION FROM BASE PLATE. SNAPPED OFF CAUSED BY PT FALL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CTM LCS PFC 3-PEG PAT SM+ ROT LXH DEPUY ORTHOPAEDICS, INC. NA D59SE1

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Required Intervention