BEUDAMED
    FDA Adverse Event Other Summary report: N

    UNKNOWN DEPUY ASR HIP (LEFT SIDE)

    MDR report key: 2113678 · Received May 11, 2011

    Report

    Report Number
    1818910-2011-08270
    Event Type
    Other
    Date Received
    May 11, 2011
    Report Date
    April 11, 2011
    Manufacturer
    DEPUY INTERNATIONAL, LTD
    Product Code
    KWA
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    PATIENT CONTACTED BROADSPIRE TO INITIATE CLAIM. PATIENT REPORTED REVISION SURGERY. REASON FOR REVISION IS UNKNOWN. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    336102 UNKNOWN DEPUY ASR HIP (LEFT SIDE) TOTAL HIP PROSTHESIS KWA DEPUY INTERNATIONAL, LTD NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1