Brand Name | RSP |
Type of Device | RSP SEMICONSTRAINED HUMERAL SOCKET INSERT, 32MM, 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 |
teffany
hutto
|
9800 metric blvd |
austin, TX 78758-5445
|
|
MDR Report Key | 8851764 |
MDR Text Key | 152969260 |
Report Number | 1644408-2019-00720 |
Device Sequence Number | 1 |
Product Code |
PHX
|
UDI-Device Identifier | 00888912144612 |
UDI-Public | (01)00888912144612 |
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 |
Report Date |
08/01/2019 |
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 Expiration Date | 01/16/2024 |
Device Model Number | 509-01-032 |
Device Catalogue Number | 509-01-032 |
Device Lot Number | 381P1096 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
07/02/2019
|
Initial Date FDA Received | 08/01/2019 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 01/18/2019 |
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 |
Patient Outcome(s) |
Other;
Required Intervention;
|
Patient Age | 59 YR |