BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENGAGE TAPER DIST BDY 27X290

    MDR report key: 1954446 · Received January 5, 2011

    Report

    Report Number
    1818910-2010-09920
    Event Type
    Injury
    Date Received
    January 5, 2011
    Date of Event
    December 6, 2010
    Report Date
    December 6, 2010
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    LPH
    PMA / PMN Number
    K033893
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IA, US
    Reporter Occupation
    OTHER

    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 REVISED FOR FRACTURE OF PROSTHESIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENGAGE TAPER DIST BDY 27X290 87LPH LPH DEPUY ORTHOPAEDICS, INC. NA ZT9H61000

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Required Intervention