MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2005-03-03 for BUCK 71279420 manufactured by Smith & Nephew, Inc.,orthopaedic Div..
[15707497]
It was reported that the product broke. No other information is available at this time.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1020279-2005-00104 |
| MDR Report Key | 577464 |
| Report Source | 07 |
| Date Received | 2005-03-03 |
| Date of Report | 2005-03-02 |
| Date Mfgr Received | 2005-02-01 |
| Date Added to Maude | 2005-03-04 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. JASON CHARMNESS, REG COMPLIANCE |
| Manufacturer Street | 1450 BROOKS ROAD |
| Manufacturer City | MEMPHIS TN 38116 |
| Manufacturer Country | US |
| Manufacturer Postal | 38116 |
| Manufacturer Phone | 9013995899 |
| Manufacturer G1 | SMITH & NEPHEW INC. |
| Manufacturer Street | 1450 BROOKS ROAD |
| Manufacturer City | MEMPHIS TN 38116 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 38116 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BUCK |
| Generic Name | CEMENT RESTRICTOR |
| Product Code | JDK |
| Date Received | 2005-03-03 |
| Returned To Mfg | 2005-02-28 |
| Model Number | NA |
| Catalog Number | 71279420 |
| Lot Number | 04EM09064 |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | NA |
| Device Eval'ed by Mfgr | N |
| Implant Flag | Y |
| Date Removed | U |
| Device Sequence No | 1 |
| Device Event Key | 567305 |
| Manufacturer | SMITH & NEPHEW, INC.,ORTHOPAEDIC DIV. |
| Manufacturer Address | 1450 E. BROOKS RD. MEMPHIS TN 38116 US |
| Baseline Brand Name | NA |
| Baseline Generic Name | CEMENT RESTRICTOR |
| Baseline Model No | NA |
| Baseline Catalog No | 71279420 |
| Baseline ID | NA |
| Baseline Device Family | RICHARDS TOTAL HIP SYSTEM |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K791125 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2005-03-03 |