FDA Adverse Event Injury Summary report: N

AMISTEM H CEMENTLESS STEM #4 LAT

MDR report key: 4504053 · Received February 9, 2015

Report

Report Number
3005180920-2015-00016
Event Type
Injury
Date Received
February 9, 2015
Report Date
July 29, 2015
Manufacturer
MEDACTA INTERNATIONAL, SA
Product Code
MEH
PMA / PMN Number
K093944
Report Source
Manufacturer report
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

ON 03/13/2015 WE RECEIVED THE CONFIRMATION THAT THE PIECES WILL NOT BE RETURNED BACK.

Additional Manufacturer Narrative · 1

ON 07/06/2015 IT WAS PREPARED A FINAL REPOR WITH THE INFORMATION COLLECTED DURING THE INVESTIGATIN, ALREADY REPORTED IN THE INITIAL REPORT AND IN THE FIRST FOLLOW UP. ON 07/07/2015 THE REPORT WAS SENT TO THE INITIAL REPORTER AND THE CASE WAS CLOSED.

Additional Manufacturer Narrative · 1

BATCH RECORD PERFORMED ON 02/06/2015: LOT 123816: (B)(4) ITEMS PRODUCED AND RELEASED ON 11/21/2012. NO ANOMALIES FOUND IN THE REVIEW. TO DATE, (B)(4) DEVICES HAVE BEEN SOLD WITHOUT ANY SIMILAR ISSUE. FEMORAL HEAD CODE 01.25.023 LOT 133525 (K072857): (B)(4) ITEMS PRODUCED AND RELEASED ON 09/09/2013. NO ANOMALIES FOUND IN THE REVIEW. TO DATE, (B)(4) DEVICES HAVE BEEN SOLD WITHOUT ANY SIMILAR ISSUE. VERSAFITCUP CC LINER CODE 01.26.3244HCT LOT 133936 (K103352): (B)(4) ITEMS PRODUCED AND RELEASED ON 10/23/2013. NO ANOMALIES FOUND IN THE REVIEW. TO DATE, (B)(4) DEVICES HAVE BEEN SOLD WITHOUT ANY SIMILAR ISSUE. VERSAFITCUP CC TRIO NO HOLE SHELL CODE 01.26.45.1154 LOT 133028 (K122911): (B)(4) ITEMS PRODUCED AND RELEASED ON 09/10/2013. NO ANOMALIES FOUND IN THE REVIEW. TO DATE, (B)(4) DEVICES HAVE BEEN SOLD WITHOUT ANY SIMILAR ISSUE.

Description of Event or Problem · 1

(B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
89859 AMISTEM H CEMENTLESS STEM #4 LAT CEMENTLESS FEMORAL STEM MEH MEDACTA INTERNATIONAL, SA

Patients

Seq Age Sex Outcome Treatment
1