Brand Name | UNIVERSAL STEM 75X16MM FLUTED |
Type of Device | UNIVERSAL KNEE STEMS AND SLEEVES : KNEE STEMS |
Manufacturer (Section D) |
DEPUY INTERNATIONAL LTD. 8010379 |
st. anthony's rd |
leeds IN LS11 8 DT |
UK LS11 8 DT |
|
Manufacturer (Section G) |
DEPUY ORTHOPAEDICS, INC. 1818910 |
700 orthopaedic drive |
|
warsaw IN 46582 0988 |
|
Manufacturer Contact |
kara
ditty-bovard
|
1210 ward avenue |
west chester, PA 19380-0988
|
6103142063
|
|
MDR Report Key | 8447634 |
MDR Text Key | 139680703 |
Report Number | 1818910-2019-88269 |
Device Sequence Number | 1 |
Product Code |
JWH
|
UDI-Device Identifier | 10603295217831 |
UDI-Public | 10603295217831 |
Combination Product (y/n) | N |
Reporter Country Code | AS |
PMA/PMN Number | K063633 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial,Followup,Followup |
Report Date |
03/05/2019 |
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 Catalogue Number | 867416 |
Device Lot Number | HA0959 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
03/05/2019 |
Initial Date FDA Received | 03/25/2019 |
Supplement Dates Manufacturer Received | 03/26/2019 04/16/2019
|
Supplement Dates FDA Received | 04/10/2019 05/08/2019
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 07/11/2017 |
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) |
Required Intervention;
|