BEUDAMED
    FDA Adverse Event Injury Summary report: N

    M/H INTERLOK (NTS)

    MDR report key: 351781 · Received September 14, 2001

    Report

    Report Number
    1825034-2001-00081
    Event Type
    Injury
    Date Received
    September 14, 2001
    Date of Event
    December 12, 1998
    Report Date
    August 14, 2001
    Manufacturer
    BIOMET, INC.
    Product Code
    JDT
    Removal / Correction Number
    Z-1064/1069-5
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT LEFT TOTAL HIP ARTHROPLASTY WAS PERFORMED IN 1991. REVISION PERFORMED IN 1998, DUE TO FRACTURE OF FEMORAL STEM PROSTHESIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    42288 M/H INTERLOK (NTS) PROSTHESIS, HIP, COMP. JDT BIOMET, INC. NA 716380

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Hospitalization| R