Brand Name | RSP |
Type of Device | RSP STANDARD HUMERAL SOCKET INSERT, 36MM, HXE-PLUS |
Manufacturer (Section D) |
ENCORE MEDICAL L.P. |
9800 metric blvd |
austin, tx 78758-5445 |
|
Manufacturer (Section G) |
ENCORE MEDICAL L.P. |
9800 metric blvd |
|
austin, tx 78758-5445 |
|
Manufacturer Contact |
teffany
hutto
|
9800 metric blvd |
austin, tx 78758-5445
|
|
MDR Report Key | 9535319 |
MDR Text Key | 173296617 |
Report Number | 1644408-2019-01294 |
Device Sequence Number | 1 |
Product Code |
PHX
|
UDI-Device Identifier | 00888912024761 |
UDI-Public | (01)00888912024761 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K051075 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
02/04/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 12/31/2019 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 01/10/2024 |
Device Model Number | 508-36-101 |
Device Catalogue Number | 509-00-036 |
Device Lot Number | 378P1178 |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 01/07/2020 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 01/14/2019 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
Required Intervention;
|
Patient Age | 52 YR |
Patient Weight | 147 |
|
|