Brand Name | R3 20 DEG +4 XLPE ACET LNR 40MM X 56OD |
Type of Device | PROSTHESIS, HIP, SEMI-CONSTRAINED, UNCEMENTED, METAL/POLYMER, POROUS |
Manufacturer (Section D) |
SMITH & NEPHEW, INC. |
1450 brooks road |
memphis TN 38116 |
|
MDR Report Key | 8222152 |
MDR Text Key | 132226854 |
Report Number | 1020279-2019-00074 |
Device Sequence Number | 1 |
Product Code |
MBL
|
UDI-Device Identifier | 00885556113042 |
UDI-Public | 00885556113042 |
Combination Product (y/n) | N |
PMA/PMN Number | K093363 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Type of Report
| Initial,Followup |
Report Date |
03/21/2019 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 01/07/2019 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 01/19/2020 |
Device Catalogue Number | 71338704 |
Device Lot Number | 10AM10418 |
Date Manufacturer Received | 12/17/2018 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Hospitalization;
Required Intervention;
|
Patient Age | 47 YR |
|
|