BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CCS

    MDR report key: 2940757 · Received September 28, 2006

    Report

    Report Number
    9613350-2006-00006
    Event Type
    Injury
    Date Received
    September 28, 2006
    Date of Event
    July 26, 2006
    Report Date
    September 28, 2006
    Manufacturer
    ZIMMER GMBH
    Product Code
    KWB
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    BREAKAGE

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CCS CCS EXPANSION CUP KWB ZIMMER GMBH NA B596904

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Hospitalization