Brand Name | RSP |
Type of Device | GLENOID, HEAD W/RETAINING SCREW, RSP, 32MM/NEUTRAL |
Manufacturer (Section D) |
ENCORE MEDICAL L.P. |
9800 metric blvd |
austin, tx 78758-5445, |
|
MDR Report Key | 10482767 |
MDR Text Key | 205311167 |
Report Number | 1644408-2020-00738 |
Device Sequence Number | 1 |
Product Code |
PHX
|
UDI-Device Identifier | 00888912024730 |
UDI-Public | (01)00888912024730 |
Combination Product (y/n) | N |
PMA/PMN Number | K051075 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative |
Type of Report
| Initial,Followup,Followup |
Report Date |
12/01/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | 508-32-101 |
Device Catalogue Number | 508-32-101 |
Device Lot Number | 862C3134 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
08/05/2020
|
Initial Date FDA Received | 09/02/2020 |
Supplement Dates Manufacturer Received | 09/23/2020 10/21/2020
|
Supplement Dates FDA Received | 10/21/2020 12/02/2020
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Treatment | 506-03-114 LOT 831C1790; 506-03-114 LOT 831C1790; 506-03-114 LOT 831C1794; 506-03-130 LOT 835C1650; 506-03-130 LOT 835C1669; 508-32-204 LOT 769P1787; 508-32-204, LOT 769P1787; 509-00-432 LOT 954W1055; 509-03-432 LOT 954W1055; 508-32-204 LOT 769P1787; 509-00-432 LOT 954W1055 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 84 YR |
|
|