Brand Name | DELTA |
Type of Device | FEMORAL COMPONENT |
Manufacturer (Section D) |
SMITH & NEPHEW, INC. |
3811 6 |
GM 38116 |
|
Manufacturer (Section G) |
SMITH & NEPHEW, INC. |
1450 brooks road |
|
memphis TN 38116 |
|
Manufacturer Contact |
melanie
travis
|
1450 brooks road |
memphis, TN 38116
|
9013996233
|
|
MDR Report Key | 3852205 |
MDR Text Key | 4682007 |
Report Number | 1020279-2014-00351 |
Device Sequence Number | 1 |
Product Code |
LPF
|
Combination Product (y/n) | N |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Company Representative |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
05/21/2014 |
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 | 71332800 |
Device Lot Number | 04ET80654 |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
05/21/2014
|
Initial Date FDA Received | 06/05/2014 |
Supplement Dates Manufacturer Received | Not provided
|
Supplement Dates FDA Received | 08/25/2014
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
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) |
Hospitalization;
Disability;
|
Patient Age | 54 YR |
|
|