BEUDAMED
    FDA Adverse Event Death Summary report: N

    UNKNOWN 28 MM DURALOCK LINER

    MDR report key: 601902 · Received May 12, 2005

    Report

    Report Number
    1818910-2005-00690
    Event Type
    Death
    Date Received
    May 12, 2005
    Date of Event
    May 10, 2005
    Report Date
    May 11, 2005
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    JDI
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    PATIENT WAS REVISED DUE TO DISLOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN 28 MM DURALOCK LINER TOTAL HIP REPLACEMENT JDI DEPUY ORTHOPAEDICS, INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Required Intervention