BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AML MMA 10.5MM 6.3 IN STEM

    MDR report key: 496801 · Received November 21, 2003

    Report

    Report Number
    1818910-2003-00764
    Event Type
    Injury
    Date Received
    November 21, 2003
    Report Date
    October 23, 2003
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    LPH
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE PT WAS REVISED DUE TO A BROKEN (RIGHT SIDE) AML STEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AML MMA 10.5MM 6.3 IN STEM TOTAL HIP REPLACEMENT LPH DEPUY ORTHOPAEDICS, INC. NA 725470

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Required Intervention