BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CONSERVE(R) TOTAL HEAD W/BFH

    MDR report key: 6059505 · Received October 26, 2016

    Report

    Report Number
    3010536692-2016-01328
    Event Type
    Injury
    Date Received
    October 26, 2016
    Date of Event
    September 26, 2016
    Report Date
    September 27, 2016
    Manufacturer
    MICROPORT ORTHOPEDICS INC.
    Product Code
    KWA
    PMA / PMN Number
    K021349
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ALLEGEDLY THE CUP SLIPPED OUT OF SOCKET (RIGHT).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    707921 CONSERVE(R) TOTAL HEAD W/BFH HIP COMPONENT KWA MICROPORT ORTHOPEDICS INC. 077458448

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Required Intervention