BEUDAMED
    FDA Adverse Event Death Summary report: N

    SELF CENT HIP 48X28 BRN

    MDR report key: 621686 · Received July 19, 2005

    Report

    Report Number
    1818910-2005-01189
    Event Type
    Death
    Date Received
    July 19, 2005
    Date of Event
    July 14, 2005
    Report Date
    July 14, 2005
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    KWY
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ID, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PATIENT CODED INTRAOPERATIVELY DUE TO NON RELATED HEALTH COMPLICATIONS. THE PATIENT WAS TO RECIEVE A SELF CENTERING HIP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SELF CENT HIP 48X28 BRN TOTAL HIP PROTHESIS KWY DEPUY ORTHOPAEDICS, INC. NA Y3EG410008

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR Death