FDA Adverse Event
Injury
Summary report: N
M/H INTERLOCK (NTS)
MDR report key: 52517
·
Received October 22, 1996
Report
- Report Number
- 1825034-1996-00021
- Event Type
- Injury
- Date Received
- October 22, 1996
- Date of Event
- September 25, 1996
- Report Date
- October 8, 1996
- Manufacturer
- BIOMET, INC
- Product Code
- JDT
- Removal / Correction Number
- Z106410695
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- OH, US
- Reporter Occupation
- PHYSICIAN
Narratives
Description of Event or Problem · 1
DEVICE WAS IMPLANTED ON 2/27/91. REVISION SURGERY WAS PERFORMED ON 9/25/96, DUE TO FRACTURE OF STEM COMPONENT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | M/H INTERLOCK (NTS) Implant | PROSTHESIS, HIP, COMP. | JDT | BIOMET, INC | NA | 367300 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 73 YR | Hospitalization| R |