BEUDAMED
    FDA Adverse Event Injury Summary report: N

    M/H INTERLOK (NTS)

    MDR report key: 43782 · Received October 19, 1996

    Report

    Report Number
    1825034-1996-00016
    Event Type
    Injury
    Date Received
    October 19, 1996
    Date of Event
    August 19, 1996
    Report Date
    September 20, 1996
    Manufacturer
    BIOMET, INC.
    Product Code
    JDT
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    DEVICE IMPLANTED ON 9/4/91. STEM COMPONENT FRACTURED AND WAS REVISED ON 8/19/96.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 M/H INTERLOK (NTS) Implant PROSTHESIS, HIP, COMP. JDT BIOMET, INC. NA 949320

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Hospitalization| R