BEUDAMED
    FDA Adverse Event Other Summary report: N

    FMP HIP

    MDR report key: 2092936 · Received May 10, 2011

    Report

    Report Number
    1644408-2011-00268
    Event Type
    Other
    Date Received
    May 10, 2011
    Date of Event
    May 2, 2011
    Report Date
    May 2, 2011
    Manufacturer
    ENCORE MEDICAL, L.P.
    Product Code
    LPH
    PMA / PMN Number
    K974093
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    THE MAN HOLE COVER PUSHED THROUGH THE CUP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FMP HIP HEMI W/HOLES SHELL LPH ENCORE MEDICAL, L.P. 288C1003

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Required Intervention