BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PS TIBIAL INSERT TRIAL #3 - 9MM

    MDR report key: 2091370 · Received May 5, 2011

    Report

    Report Number
    2249697-2011-00663
    Event Type
    Malfunction
    Date Received
    May 5, 2011
    Date of Event
    April 18, 2011
    Report Date
    April 18, 2011
    Manufacturer
    STRYKER ORTHOPAEDICS MAHWAH
    Product Code
    LXH
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    A SUPPLEMENTAL REPORT WILL BE SUBMITTED UPON COMPLETION OF THE INVESTIGATION.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT, "WE PUT IN THE TRIAL AND COULDN'T GET IT TO LOCK INTO THE TRIAL BASEPLATE."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PS TIBIAL INSERT TRIAL #3 - 9MM INSTRUMENT LXH STRYKER ORTHOPAEDICS MAHWAH NA PPM4J28

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Other