BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEPUY INC

    MDR report key: 776973 · Received November 2, 2006

    Report

    Report Number
    MW1040872
    Event Type
    Injury
    Date Received
    November 2, 2006
    Date of Event
    October 25, 2006
    Report Date
    November 2, 2006
    Manufacturer
    DEPUY INC
    Product Code
    KWY
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    REMOVAL OF BROKEN HIP STEM IMPLANT, IMPLANTED IN 1999 BUT SHOULD HAVE LASTED AT LEAST 10 YRS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DEPUY INC PRODIGY HIP STEM IMPLANT KWY DEPUY INC * T13C21004

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Disability