BEUDAMED
    FDA Adverse Event Injury Summary report: N

    14/16 LG TAPER M HEAD 36MM+5

    MDR report key: 2002890 · Received February 16, 2011

    Report

    Report Number
    1818910-2011-02216
    Event Type
    Injury
    Date Received
    February 16, 2011
    Date of Event
    January 17, 2011
    Report Date
    January 17, 2011
    Manufacturer
    DEPUY INTERNATIONAL, LTD.
    Product Code
    JDI
    PMA / PMN Number
    K980513
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, 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 WAS REVISED TO ADDRESS DISLOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 14/16 LG TAPER M HEAD 36MM+5 87JDI JDI DEPUY INTERNATIONAL, LTD. NA 3096055

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Required Intervention