Brand Name | PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED |
Type of Device | PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED |
Manufacturer (Section D) |
|
MDR Report Key | 10837559 |
MDR Text Key | 216409587 |
Report Number | MW5097858 |
Device Sequence Number | 1 |
Product Code |
KWS
|
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Voluntary
|
Reporter Occupation |
Patient
|
Type of Report
| Initial |
Report Date |
11/10/2020 |
4 Devices were Involved in the Event: |
1
2
3
4
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
No Information
|
Device Model Number | DWD003 |
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 11/12/2020 |
Was Device Evaluated by Manufacturer? |
No Information
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Disability;
|
Patient Age | 57 YR |
Patient Weight | 90 |
|
|