BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BHR

    MDR report key: 3151273 · Received June 7, 2013

    Report

    Report Number
    3005477969-2013-00229
    Event Type
    Injury
    Date Received
    June 7, 2013
    Date of Event
    May 23, 2013
    Report Date
    August 1, 2013
    Manufacturer
    SMITH & NEPHEW ORTHOPAEDICS LTD
    Product Code
    NXT
    PMA / PMN Number
    P040033
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT REVISION SURGERY WAS PERFORMED DUE TO LOOSENING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    252071 BHR DYSPLASIA CUP NXT SMITH & NEPHEW ORTHOPAEDICS LTD 50559

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Hospitalization| R FEMORAL HEAD, PART # 74121146, LOT # 78695| DYSPLASIA SCREW, #74500028, # 06MM11496 044| DYSPLASIA SCREW, #74500040, # 06MM11499