BEUDAMED
    FDA Adverse Event Injury Summary report: N

    NOVATION CROWN ACETABULAR CUP

    MDR report key: 3874856 · Received June 9, 2014

    Report

    Report Number
    1038671-2014-00234
    Event Type
    Injury
    Date Received
    June 9, 2014
    Date of Event
    January 8, 2014
    Report Date
    June 5, 2014
    Manufacturer
    EXACTECH, INC.
    Product Code
    KWA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE CONTRIBUTION OF THE DEVICES TO THE EXPERIENCE REPORTED COULD NOT BE DETERMINED AS THE DEVICES WERE NOT RETURNED FOR EVAL. ADDITIONALLY, THE DEVICE SPECIFIC IDENTIFICATION INFO WAS NOT PROVIDED, PRECLUDING A REVIEW OF THE DEVICE HISTORY RECORD.

    Description of Event or Problem · 1

    DURING THE PROCEDURE, PT PRESENTED WITH CALCAL FISSURE. CORRECTED IMMEDIATELY WITH WIRE TIES. THIS EVENT REPORT WAS RECEIVED THROUGH CLINICAL DATA COLLECTION ACTIVITIES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    334251 NOVATION CROWN ACETABULAR CUP ACETABULAR CUP KWA EXACTECH, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R