Brand Name | PINN SECTOR W/GRIPTION 50MM |
Type of Device | PINNACLE HIP SYSTEM : HIP METAL ACETABULAR CUPS |
Manufacturer (Section D) |
DEPUY ORTHOPAEDICS INC US |
700 orthopaedic drive |
warsaw IN 46581 0988 |
|
Manufacturer (Section G) |
DEPUY ORTHOPAEDICS, INC. 1818910 |
700 orthopaedic dr. |
|
warsaw IN 46581 0988 |
|
Manufacturer Contact |
kara
ditty-bovard
|
700 orthopaedic dr. |
warsaw, IN 46581-0988
|
6107428552
|
|
MDR Report Key | 12908084 |
MDR Text Key | 281512232 |
Report Number | 1818910-2021-26614 |
Device Sequence Number | 1 |
Product Code |
KWA
|
UDI-Device Identifier | 10603295010296 |
UDI-Public | 10603295010296 |
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | K093646 |
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 |
12/01/2021 |
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 | 1217-32-050 |
Device Catalogue Number | 121732050 |
Device Lot Number | 9820981 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
11/12/2021 |
Initial Date FDA Received | 12/01/2021 |
Supplement Dates Manufacturer Received | 12/17/2021
|
Supplement Dates FDA Received | 12/20/2021
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 07/19/2021 |
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 |
Treatment | ALTRX NEUT 32IDX50OD.; ARTICUL/EZE BALL 32 +5 BR.; CORAIL AMT COLLAR SIZE 11.; PINN SECTOR W/GRIPTION 50MM. |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 66 YR |
Patient Sex | Female |
Patient Weight | 89 KG |