BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ITST INTERTROCHANTERIC/SUBTROCHANTERIC FIXATION LAG SCREW

    MDR report key: 413904 · Received August 30, 2002

    Report

    Report Number
    1822565-2002-00103
    Event Type
    Injury
    Date Received
    August 30, 2002
    Date of Event
    June 7, 2002
    Report Date
    July 31, 2002
    Manufacturer
    ZIMMER, INC.
    Product Code
    NDE
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    ANTI-ROTATION SCREW AND LAG SCREW CUT OUT OF FEMORAL HEAD/NECK. PATIENT HAD A HISTORY OF AVASCULAR NECROSIS. DEVICES REMOVED AND REVISED TO A TOTAL HIP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ITST INTERTROCHANTERIC/SUBTROCHANTERIC FIXATION LAG SCREW LAG SCREW NDE ZIMMER, INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR Hospitalization| R