BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNK COONRAD/MORREY HUMERAL IMPLANT

    MDR report key: 2993865 · Received March 1, 2013

    Report

    Report Number
    1822565-2013-00420
    Event Type
    Injury
    Date Received
    March 1, 2013
    Date of Event
    September 29, 2010
    Report Date
    January 30, 2013
    Manufacturer
    ZIMMER, INC.
    Product Code
    HSD
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS REPORT WILL BE AMENDED WHEN OUT INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE PT WAS REVISED DUE TO ASEPTIC LOOSENING OF THE HUMERAL COMPONENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    89473 UNK COONRAD/MORREY HUMERAL IMPLANT EXTREMETIRY PROSTHESIS HSD ZIMMER, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR Required Intervention