BEUDAMED
    FDA Adverse Event Injury Summary report: N

    STRYKER ORTHOPAEDICS

    MDR report key: 544887 · Received September 16, 2004

    Report

    Report Number
    544887
    Event Type
    Injury
    Date Received
    September 16, 2004
    Date of Event
    June 28, 2004
    Report Date
    September 13, 2004
    Manufacturer
    STRYKER ORTHOPAEDICS
    Product Code
    KWB
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    WA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    FAILED ACETABULUM PT HAD TOTAL HIP 3 MONTHS PREVIOUSLY. ACETABULUM SLIPPED INTO VALGIS CAUSING PAIN AFTER HIP SUBLUXED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 STRYKER ORTHOPAEDICS ACETABULAR SHELL, INSERT, SCREWS KWB STRYKER ORTHOPAEDICS 542-11-54F *

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR Hospitalization #'S ON STICKER, ID#10000027MP