BEUDAMED
    FDA Adverse Event Other Summary report: N

    CUP, AL-AL FLARED RIM

    MDR report key: 983726 · Received January 18, 2008

    Report

    Report Number
    1644408-2008-00014
    Event Type
    Other
    Date Received
    January 18, 2008
    Date of Event
    December 20, 2007
    Report Date
    January 18, 2008
    Manufacturer
    ENCORE MEDICAL, L.P.
    Product Code
    KWB
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY DUE TO DISLOCATION. REPLACED CUP, LINER, AND HEAD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CUP, AL-AL FLARED RIM AL-AL SHELLS KWB ENCORE MEDICAL, L.P. 53812714

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR Required Intervention 498-28-048 LOT #53862343| 400-01-290 LOT #247232K1