BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PROFEMUR(R) MODULAR FEMORAL NECK

    MDR report key: 4111364 · Received September 23, 2014

    Report

    Report Number
    3010536692-2014-01408
    Event Type
    Injury
    Date Received
    September 23, 2014
    Date of Event
    September 1, 2014
    Report Date
    September 1, 2014
    Manufacturer
    MICROPORT ORTHOPEDICS INC.
    Product Code
    LWJ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AU
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    INVESTIGATION IS NOT COMPLETE; REPORT WILL BE UPDATED WHEN COMPLETE. TRENDS WILL BE EVALUATED. THIS EVENT OCCURRED IN (B)(6).

    Description of Event or Problem · 1

    ALLEGEDLY THE PT. STUMBLED OVER A SILL AND FELL ON LEFT HIP, BREAKING NECK COMPONENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    589881 PROFEMUR(R) MODULAR FEMORAL NECK HIP COMPONENT LWJ MICROPORT ORTHOPEDICS INC. W1037279

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention