Brand Name | EXPRT REVISION KNEE |
Type of Device | INSERT, REVISION EXPRT, SZ C X 19.5MM, E-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 | 9349526 |
MDR Text Key | 167342817 |
Report Number | 1644408-2019-01113 |
Device Sequence Number | 1 |
Product Code |
JWH
|
UDI-Device Identifier | 00888912114110 |
UDI-Public | (01)00888912114110 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K140830 |
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 |
11/19/2019 |
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 | 07/25/2023 |
Device Model Number | 315-0C-719 |
Device Catalogue Number | 315-0C-719 |
Device Lot Number | 014R1014 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
10/24/2019
|
Initial Date FDA Received | 11/20/2019 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 07/30/2018 |
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;
Required Intervention;
|
Patient Age | 78 YR |