BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ULTRA TIB INS RT SZ1/2 9MM NK II

    MDR report key: 509121 · Received January 30, 2004

    Report

    Report Number
    2935620-2004-00006
    Event Type
    Injury
    Date Received
    January 30, 2004
    Date of Event
    December 30, 2003
    Report Date
    January 30, 2004
    Manufacturer
    CENTERPULSE ORTHOPEDICS, INC.
    Product Code
    HSH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED: PT WAS REVISED FOR RIGHT KNEE IN 2003.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ULTRA TIB INS RT SZ1/2 9MM NK II KNEE PROSTHESIS HSH CENTERPULSE ORTHOPEDICS, INC. NA 1198199

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Hospitalization