BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN ZIMMER HIP

    MDR report key: 1930692 · Received December 14, 2010

    Report

    Report Number
    1822565-2010-01348
    Event Type
    Injury
    Date Received
    December 14, 2010
    Date of Event
    October 21, 2009
    Report Date
    November 17, 2010
    Manufacturer
    ZIMMER, INC.
    Product Code
    JDG
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    INFO WAS RECEIVED FROM A CONSUMER WHO IS NOT REQUIRED TO COMPLETE FORM 3500A. THIS REPORT WILL BE AMENDED WHEN OUR INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    IT IS REPORTING THAT THE PT WAS REVISED DUE TO PAIN AND LOOSENING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN ZIMMER HIP HIP PROSTHESIS JDG ZIMMER, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention