BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CONSERVE(R) PLUS CUP

    MDR report key: 2060192 · Received April 15, 2011

    Report

    Report Number
    1043534-2011-00154
    Event Type
    Injury
    Date Received
    April 15, 2011
    Date of Event
    January 3, 2011
    Report Date
    March 15, 2011
    Manufacturer
    WRIGHT MEDICAL TECHNOLOGY, INC.
    Product Code
    KWA
    PMA / PMN Number
    K021349
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Additional Manufacturer Narrative · 1

    CONCLUSION: NO DEVICE FAILURE. COMPLAINT REVIEWED AND ANALYSIS SHOWED NO TREND FOR 3802-5662 LOT NO: 065220935. DEVICE HISTORY RECORD REVIEWED. PRODUCT NOT RETURNED. EVIDENCE THAT PRODUCT IN SPECIFICATION WHEN USED; UNDETERMINED.

    Additional Manufacturer Narrative · 1

    DEVICE #4: INVESTIGATION IS NOT COMPLETE. TRENDS WILL BE EVALUATED. NO COMPLAINT WAS STATED AGAINST THIS DEVICE. THIS REPORT WILL BE UPDATED WHEN THE INVESTIGATION IS COMPLETED. THIS IS THE SAME EVENT AS 1043534-2011-00151, 00152, 00153.

    Description of Event or Problem · 1

    ALLEGEDLY REMOVED DURING THE REVISION OF ANOTHER COMPONENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CONSERVE(R) PLUS CUP HIP COMPONENT KWA WRIGHT MEDICAL TECHNOLOGY, INC. 065220935

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Hospitalization| R