BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEPUY PROSTHESIS

    MDR report key: 18609 · Received August 2, 1994

    Report

    Report Number
    18609
    Event Type
    Injury
    Date Received
    August 2, 1994
    Date of Event
    March 31, 1994
    Report Date
    March 31, 1994
    Manufacturer
    DEPUY
    Product Code
    JDG
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    ME, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    S/P THA POLYETHELYNE FAILURE. PATIENT DIAGNOSED WITH RIGHT HIP PAIN. REVISION THA RT. 3/31/94.(D-6) PRODUCT MODEL # - CUP #1107-56-000 INSERT #1115-22-000 FEMORAL #1041-20-000 PRODUCT LOT # - CUP #896820019 INSERT #870360052 FEMORAL #664780005

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DEPUY PROSTHESIS Implant CUP INSERT FEMORAL JDG DEPUY SEE #5

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Required Intervention