BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ELITE MODULAR HD 32MM +0

    MDR report key: 1833310 · Received September 9, 2010

    Report

    Report Number
    1818910-2010-06027
    Event Type
    Injury
    Date Received
    September 9, 2010
    Date of Event
    August 10, 2010
    Report Date
    August 10, 2010
    Manufacturer
    DEPUY INTERNATIONAL, LTD.
    Product Code
    JDI
    PMA / PMN Number
    K871867
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, 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

    PATIENT WAS REVISED TO ADDRESS DISLOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ELITE MODULAR HD 32MM +0 87JDI JDI DEPUY INTERNATIONAL, LTD. NA 1120454

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Required Intervention