BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CORMET RESURFACING

    MDR report key: 4574792 · Received May 16, 2014

    Report

    Report Number
    9614209-2014-00046
    Event Type
    Injury
    Date Received
    May 16, 2014
    Date of Event
    April 18, 2014
    Report Date
    May 15, 2014
    Manufacturer
    CORIN MEDICAL, LTD.
    Product Code
    NXT
    PMA / PMN Number
    P050016
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4) INITIAL REPORT. DEVICE DETAILS, PT MEDICAL HISTORY, POST PRIMARY AND PRE-REVISION X-RAYS, EXPLANT AND REASON FOR REVISION HAVE BEEN REQUESTED IN ORDER TO PROGRESS WITH THE INVESTIGATION. DEVICE MFG RECORDS TO BE REVIEWED.

    Description of Event or Problem · 1

    CORMET RIGHT HIP REVISION AFTER 5 YEARS 5 MONTHS DUE TO LOOSE ACETABULAR COMPONENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    295394 CORMET RESURFACING METAL ON METAL RE-SURFACING NXT CORIN MEDICAL, LTD. 570-06-054 LBWY

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR Required Intervention