BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DUR MAR +4 10D LNR 36X54

    MDR report key: 1903212 · Received November 12, 2010

    Report

    Report Number
    1818910-2010-08100
    Event Type
    Injury
    Date Received
    November 12, 2010
    Date of Event
    October 14, 2010
    Report Date
    October 14, 2010
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    LPH
    PMA / PMN Number
    K010171
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    OTHER
    Health Professional
    Yes

    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 WAS REVISED TO ADDRESS INFECTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DUR MAR +4 10D LNR 36X54 87LPH LPH DEPUY ORTHOPAEDICS, INC. NA D13PE1000

    Patients

    Seq Age Sex Outcome Treatment
    1 Female Required Intervention