FDA Adverse Event
Injury
Summary report: N
VERSYS HIP SYSTEM REVISION FEMORAL STEM
MDR report key: 2210652
·
Received August 10, 2011
Report
- Report Number
- 1822565-2011-01838
- Event Type
- Injury
- Date Received
- August 10, 2011
- Date of Event
- July 5, 2011
- Report Date
- July 13, 2011
- Manufacturer
- ZIMMER, INC.
- Product Code
- LPH
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IL, US
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
INFORMATION WAS RECEIVED FROM A DISTRIBUTOR WHO IS NOT REQUIRED TO COMPLETE FORM 3500A. THIS REPORT WILL BE AMENDED WHEN OUR INVESTIGATION IS COMPLETE.
Description of Event or Problem · 1
IT IS REPORTED THAT THE PATIENT WAS REVISED FOR A BROKEN STEM.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | VERSYS HIP SYSTEM REVISION FEMORAL STEM | LPH | ZIMMER, INC. | 60026337 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 83 YR | Required Intervention |