BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ONE-THIRD TUBULAR PLATE WITH COLLAR

    MDR report key: 1895292 · Received November 2, 2010

    Report

    Report Number
    1822565-2010-01051
    Event Type
    Injury
    Date Received
    November 2, 2010
    Date of Event
    August 18, 2010
    Report Date
    October 5, 2010
    Manufacturer
    ZIMMER, INC.
    Product Code
    KWY
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS REPORT WILL BE AMENDED WHEN OUR INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE PT WAS REVISED DUE TO BREAKAGE OF THE PLATE. X-RAYS CONFIRMED PRIOR TO SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ONE-THIRD TUBULAR PLATE WITH COLLAR TRAUMA PROSTHESIS KWY ZIMMER, INC. 60812281

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Required Intervention