BEUDAMED
    FDA Adverse Event Injury Summary report: N

    R3 3 HOLE ACET SHELL

    MDR report key: 4113624 · Received September 24, 2014

    Report

    Report Number
    1020279-2014-00580
    Event Type
    Injury
    Date Received
    September 24, 2014
    Date of Event
    September 19, 2014
    Report Date
    September 19, 2014
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    JDH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SF
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED A REVISION SURGERY WAS PERFORMED DUE TO PAINFUL HIP AND LIMP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    595580 R3 3 HOLE ACET SHELL 54MM OD JDH SMITH & NEPHEW, INC. 14FM07988

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Hospitalization| R 71369894 LOT 14EM21384| 71335754 LOT 14EM09578| 71336500 LOT 13LM18923