BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SELF CENT HIP 45X28 GRY

    MDR report key: 2163377 · Received July 8, 2011

    Report

    Report Number
    1818910-2011-12216
    Event Type
    Injury
    Date Received
    July 8, 2011
    Date of Event
    June 8, 2011
    Report Date
    June 8, 2011
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    KWY
    PMA / PMN Number
    K812672
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MS, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THIS COMPLAINT IS STILL UNDER INVESTIGATION. DEPUY WILL NOTIFY THE FDA OF THE RESULTS OF THIS INVESTIGATION ONCE IT HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    PT WAS REVISED TO ADDRESS DISLOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SELF CENT HIP 45X28 GRY 87KWY KWY DEPUY ORTHOPAEDICS, INC. NA EH8H31

    Patients

    Seq Age Sex Outcome Treatment
    1 85 YR Required Intervention