FDA Adverse Event
Injury
Summary report: N
TRIATHLON-CR FEMORAL COMPONENT CEMEMTED #3 RIGHT
MDR report key: 1832040
·
Received September 8, 2010
Report
- Report Number
- 9610726-2010-00287
- Event Type
- Injury
- Date Received
- September 8, 2010
- Date of Event
- January 8, 2008
- Report Date
- August 24, 2010
- Manufacturer
- STRYKER ORTHOPAEDICS LIMERICK
- Product Code
- JWH
- PMA / PMN Number
- K040267
- Removal / Correction Number
- NA
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- NJ, US
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
AN EVALUATION OF THE DEVICE CANNOT BE PERFORMED AS THE DEVICE WAS NOT RETURNED TO THE MANUFACTURER. IF ADDITIONAL INFORMATION BECOMES AVAILABLE, IT WILL BE SUBMITTED IN A SUPPLEMENTAL REPORT.
Description of Event or Problem · 1
SIGNS/SYMPTOMS/DISEASE BEING REPORTED: PAIN, POOR ROM, SERIOUSNESS - NECESSITATED MEDICAL OR SURGICAL INTERVENTION TO PRECLUDE PERMANENT IMPAIRMENT OF A BODY FUNCTION OR PERMANENT DAMAGE TO A BODY STRUCTURE, NOT RELATED TO DEVICE, OPERATIVE SITE EVENTS = ARTHROFIBROSIS, SURGICAL MANIPULATION UNDER ANESTHETIC, WITH A RESOLUTION OF EVENT RESOLVED AS OF (B)(6)2008.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | TRIATHLON-CR FEMORAL COMPONENT CEMEMTED #3 RIGHT | IMPLANT | JWH | STRYKER ORTHOPAEDICS LIMERICK | NA | SD6KL1 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 61 YR | Required Intervention |