BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN LEFT HIP NECK

    MDR report key: 2893481 · Received December 21, 2012

    Report

    Report Number
    9616680-2012-01485
    Event Type
    Injury
    Date Received
    December 21, 2012
    Date of Event
    June 1, 2010
    Report Date
    December 3, 2012
    Manufacturer
    STRYKER ORTHOPAEDICS CORK
    Product Code
    JDI
    PMA / PMN Number
    UNK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    AT THIS TIME, THE PT WAS UNABLE TO IDENTIFY THE DEVICES IMPLANTED BUT BELIEVES THEM TO BE EITHER REJUVENATE OR ABG II. ADDITIONAL INFO HAS BEEN REQUESTED AND IF RECEIVED, WILL BE PROVIDED IN A SUPPLEMENTAL REPORT.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PT IS CURRENTLY EXPERIENCING PAIN. THE PT HAD WENT TO SEE HER SURGEON AND HAD TESTS DONE. THE SURGEON STATES THAT PT NEEDS REVISION SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN LEFT HIP NECK IMPLANT JDI STRYKER ORTHOPAEDICS CORK NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Other| R