BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNK PEG FOR DVR SYSTEM

    MDR report key: 1962425 · Received January 7, 2011

    Report

    Report Number
    1818910-2011-00387
    Event Type
    Injury
    Date Received
    January 7, 2011
    Date of Event
    December 9, 2010
    Report Date
    December 9, 2010
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    LXT
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, 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

    DVR COMPONENTS BOTHERED PT WHILE LIFTING WEIGHTS; ELECTED TO REMOVE COMPONENTS. THE SURGEON WAS ONLY ABLE TO REMOVE ONE PEG THAT WAS FOUND BROKEN AND WAS UNABLE TO REMOVE THE PLATE AND REMAINING PEGS AND SCREWS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNK PEG FOR DVR SYSTEM UNK LXT DEPUY ORTHOPAEDICS, INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 20 YR Required Intervention