Brand Name | ARTICULEZE M HEAD 36MM +5 |
Type of Device | ARTICULEZE HEAD (12/14 TAPER) : HIP METAL FEMORAL HEADS |
Manufacturer (Section D) |
DEPUY ORTHOPAEDICS INC US |
700 orthopaedic drive |
warsaw IN 46581 0988 |
|
Manufacturer (Section G) |
DEPUY IRELAND 9616671 |
loughbeg, ringaskiddy co. |
|
cork LS11 8DT |
EI
LS11 8DT
|
|
Manufacturer Contact |
kara
ditty-bovard
|
700 orthopaedic dr. |
warsaw, IN 46581-0988
|
6107428552
|
|
MDR Report Key | 13505346 |
MDR Text Key | 285394865 |
Report Number | 1818910-2022-02632 |
Device Sequence Number | 1 |
Product Code |
JDI
|
UDI-Device Identifier | 10603295033936 |
UDI-Public | 10603295033936 |
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | K980513 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Study,Health Professional |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial,Followup |
Report Date |
02/10/2022 |
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 | 1365-52-000 |
Device Catalogue Number | 136552000 |
Device Lot Number | 9795320 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
02/01/2022
|
Initial Date FDA Received | 02/10/2022 |
Supplement Dates Manufacturer Received | 03/18/2022
|
Supplement Dates FDA Received | 03/21/2022
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 06/25/2021 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Removal/Correction Number | N/A |
Patient Sequence Number | 1 |
Treatment | ALTRX NEUT 36IDX58OD.; CORAIL AMT COLLAR SIZE 13.; PINN SECTOR W/GRIPTION 58MM. |
Patient Outcome(s) |
Required Intervention;
|
Patient Sex | Male |
Patient Weight | 101 KG |