BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ULTIMA CEM FEM HIP STEM SZ 2

    MDR report key: 2002236 · Received February 18, 2011

    Report

    Report Number
    1818910-2011-02497
    Event Type
    Injury
    Date Received
    February 18, 2011
    Date of Event
    January 19, 2011
    Report Date
    January 19, 2011
    Manufacturer
    DEPUY INTERNATIONAL, LTD.
    Product Code
    KWL
    PMA / PMN Number
    K924379
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, 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 LOOSE STEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ULTIMA CEM FEM HIP STEM SZ 2 87KWL KWL DEPUY INTERNATIONAL, LTD. NA 1920840

    Patients

    Seq Age Sex Outcome Treatment
    1 87 YR Required Intervention