BEUDAMED
    FDA Adverse Event Other Summary report: N

    RSP SHOULDER

    MDR report key: 1912764 · Received November 2, 2010

    Report

    Report Number
    1644408-2010-00593
    Event Type
    Other
    Date Received
    November 2, 2010
    Date of Event
    October 27, 2010
    Report Date
    October 27, 2010
    Manufacturer
    ENCORE MEDICAL, L.P.
    Product Code
    KWS
    PMA / PMN Number
    K051075
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY - THE PT HAD A BAD FALL AND DISLOCATED HIS SHOULDER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RSP SHOULDER HUMERAL SOCKET KWS ENCORE MEDICAL, L.P. 53810992

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Required Intervention 508-32-104, LOT 53813198