BEUDAMED
    FDA Adverse Event Other Summary report: N

    CLP HIP

    MDR report key: 1960273 · Received January 7, 2011

    Report

    Report Number
    1644408-2011-00019
    Event Type
    Other
    Date Received
    January 7, 2011
    Date of Event
    December 16, 2010
    Report Date
    December 16, 2010
    Manufacturer
    ENCORE MEDICAL, L.P.
    Product Code
    KWA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY - THE CLP STEM WAS LOOSE AND UNDERSIZED, REPLACED WITH ZIMMER STEM AND HEAD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CLP HIP UNKNOWN STEM KWA ENCORE MEDICAL, L.P. NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention