BEUDAMED
    FDA Adverse Event Other Summary report: N

    RSP SHOULDER

    MDR report key: 2011685 · Received March 1, 2011

    Report

    Report Number
    1644408-2011-00118
    Event Type
    Other
    Date Received
    March 1, 2011
    Date of Event
    February 23, 2011
    Report Date
    February 23, 2011
    Manufacturer
    ENCORE MEDICAL, L.P.
    Product Code
    KWS
    PMA / PMN Number
    K051075
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AR, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY - THE PT FELL ON ICE AND DISLOCATED HIS SHOULDER, COULD NOT REDUCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RSP SHOULDER GLENOID HEAD W/ RETAINING SCREW KWS ENCORE MEDICAL, L.P. 862C1016

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Required Intervention (B)(4), LOT 833C1010| (B)(4), LOT 855C1010