BEUDAMED
    FDA Adverse Event Death Summary report: N

    PROFEMUR(R) MODULAR FEMORAL NECK

    MDR report key: 4033244 · Received August 25, 2014

    Report

    Report Number
    3010536692-2014-01222
    Event Type
    Death
    Date Received
    August 25, 2014
    Date of Event
    August 3, 2012
    Report Date
    August 6, 2014
    Manufacturer
    MICROPORT ORTHOPEDICS INC.
    Product Code
    LWJ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ALLEGEDLY THE PATIENT WAS REVISED DUE TO BROKEN MODULAR NECK (RIGHT) AND ALLEGEDLY SUFFERED A HEART ATTACK DUE TO THE STRESS ON HIS BODY CAUSED BY THE EMERGENCY REVISION SURGERY. THE PATIENT DIED ON (B)(6) 2012.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    510916 PROFEMUR(R) MODULAR FEMORAL NECK HIP COMPONENT LWJ MICROPORT ORTHOPEDICS INC. U0570553

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Death