MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1992-12-24 for UNIVERSAL CEMENT PLUG 1000-0200 manufactured by Biodynamics.
[1701]
Total hip replacement - left hip. Problem as per informant: patient death possibly rerlated to air embolusinvalid data - regarding single use labeling of device. Patient medical status prior to event: invalid data. Invalid data - regarding multiple patient involvement. Invalid data - on device service/maintenance. No data - regarding date last serviced. Service provided by: invalid data. Invalid data - service records availability. Invalid data - regarding whether event presents imminent hazard. Invalid data - whether device used as labeled/intended. Invalid data - regarding evaluation by user after event. Method of evaluation: invalid data. Results of evaluation: invalid data. Conclusion: invalid data. Certainty of device as cause of or contributor to event: invalid data. Corrective actions: no data. Invalid data - on device destroyed/disposed of status.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 33098-1992-00002 |
| MDR Report Key | 1981 |
| Date Received | 1992-12-24 |
| Date of Report | 1992-12-08 |
| Date of Event | 1992-12-02 |
| Date Facility Aware | 1992-12-07 |
| Report Date | 1992-12-08 |
| Date Reported to FDA | 1992-12-08 |
| Date Reported to Mfgr | 1992-12-08 |
| Date Added to Maude | 1993-01-04 |
| Event Key | 0 |
| Report Source Code | Distributor report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Reporter Occupation | UNKNOWN |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | UNIVERSAL CEMENT PLUG |
| Product Code | MJW |
| Date Received | 1992-12-24 |
| Catalog Number | 1000-0200 |
| Lot Number | 16611 |
| Device Availability | * |
| Implant Flag | * |
| Device Sequence No | 1 |
| Device Event Key | 1844 |
| Manufacturer | BIODYNAMICS |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Death | 1992-12-24 |