BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PFR 12.0MM X 175MM COCR

    MDR report key: 654815 · Received December 20, 2005

    Report

    Report Number
    1818910-2005-02685
    Event Type
    Injury
    Date Received
    December 20, 2005
    Date of Event
    November 22, 2005
    Report Date
    November 22, 2005
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    JDD
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    PT WAS REVISED DUE TO FRACTURE OF THE FEMORAL STEM. PT HAS SUFFERED (2) MINOR FALLS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PFR 12.0MM X 175MM COCR TOTAL HIP REPLACEMENT JDD DEPUY ORTHOPAEDICS, INC. NA 374960008

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Required Intervention