Brand Name | RSP |
Type of Device | RSP SEMICONSTRAINED 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 |
james
mcmahon
|
9800 metric blvd |
austin, tx 78758-5445
|
|
MDR Report Key | 14645971 |
MDR Text Key | 293690781 |
Report Number | 1644408-2022-00722 |
Device Sequence Number | 1 |
Product Code |
PHX
|
UDI-Device Identifier | 00888912144629 |
UDI-Public | (01)00888912144629 |
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 |
Non-Healthcare Professional
|
Type of Report
| Initial,Followup |
Report Date |
06/17/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 06/09/2022 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 03/25/2024 |
Device Model Number | 509-01-036 |
Device Catalogue Number | 509-01-036 |
Device Lot Number | 382P1065 |
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 06/16/2022 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 03/27/2019 |
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 |
Treatment | 506-03-118 LOT 832C1837; 506-03-126 LOT 834C1856; 506-03-126 LOT 834C1884; 508-32-204 LOT 769P2143; 508-36-101 LOT 869C3298; 530-12-108 LOT 412T1567 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 62 YR |
Patient Sex | Male |