BEUDAMED
    FDA Adverse Event Injury Summary report: N

    M/H INTERLOK (NTS)

    MDR report key: 421350 · Received October 9, 2002

    Report

    Report Number
    1825034-2002-00092
    Event Type
    Injury
    Date Received
    October 9, 2002
    Date of Event
    August 26, 2002
    Report Date
    October 9, 2002
    Manufacturer
    BIOMET, INC.
    Product Code
    JDT
    Removal / Correction Number
    Z-1064/1069-5
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    LEFT TOTAL HIP ARTHROPLASTY REPORTEDLY PERFORMED ON AN UNKNOWN DATE IN 1991. PT FELL GETTING OUT OF SHOWER IN 2002. FEMORAL STEM FRACTURED AND WAS REPLACED IN 2002.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 M/H INTERLOK (NTS) PROSTHESIS, HIP, COMP JDT BIOMET, INC. NA 517320

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R