BEUDAMED
    FDA Adverse Event Other Summary report: N

    UNKNOWN

    MDR report key: 1943654 · Received December 14, 2010

    Report

    Report Number
    1644408-2010-00663
    Event Type
    Other
    Date Received
    December 14, 2010
    Date of Event
    November 29, 2010
    Report Date
    November 29, 2010
    Manufacturer
    ENCORE MEDICAL, L.P.
    Product Code
    JDI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY - DUE TO DISLOCATION OF THE SHELL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN UNKNOWN JDI ENCORE MEDICAL, L.P. 53810991

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Required Intervention