BEUDAMED
    FDA Adverse Event Death Summary report: N

    SOL 13.5 STD 8.0 FULL PC 12/14

    MDR report key: 512668 · Received February 23, 2004

    Report

    Report Number
    1818910-2004-00159
    Event Type
    Death
    Date Received
    February 23, 2004
    Date of Event
    February 12, 2004
    Report Date
    February 12, 2004
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    LPH
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE TOTAL HIP PATIENT, SUDDENLY EXPERIENCED CARDIAC ARREST AND EXPIRED AFTER THE NON-CEMENTED STEM WAS IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SOL 13.5 STD 8.0 FULL PC 12/14 TOTAL HIP REPLACEMENT LPH DEPUY ORTHOPAEDICS, INC. NA X47GE1000

    Patients

    Seq Age Sex Outcome Treatment
    1 37 YR Death