BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EMPERION

    MDR report key: 2110648 · Received June 1, 2011

    Report

    Report Number
    1020279-2011-00184
    Event Type
    Injury
    Date Received
    June 1, 2011
    Date of Event
    June 23, 2010
    Report Date
    June 1, 2011
    Manufacturer
    SMITH AND NEPHEW, INC
    Product Code
    LZO
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED A REVISION SURGERY WAS PERFORMED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EMPERION HIP STEM LZO SMITH AND NEPHEW, INC 06HM02019

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Hospitalization