MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2018-03-06 for EXP ACETABULAR SHELL AND LINER SC3349-36-5456 manufactured by Stelkast Inc..
[101616926]
An evaluation of the device cannot be performed as the device was not returned. The evidence suggests that this is not a device related incident.
Patient Sequence No: 1, Text Type: N, H10
[101616927]
Patient presented for hip revision surgery because of hip dislocation.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2530191-2018-00029 |
| MDR Report Key | 7317125 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2018-03-06 |
| Date of Report | 2018-03-06 |
| Date of Event | 2018-02-21 |
| Date Mfgr Received | 2018-02-26 |
| Device Manufacturer Date | 2012-02-01 |
| Date Added to Maude | 2018-03-06 |
| 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. JOHN REYHER |
| Manufacturer Street | 200 HIDDEN VALLEY ROAD |
| Manufacturer City | MCMURRAY PA 15317 |
| Manufacturer Country | US |
| Manufacturer Postal | 15317 |
| Manufacturer Phone | 7249416368 |
| Manufacturer G1 | STELKAST INC. |
| Manufacturer Street | 200 HIDDEN VALLEY ROAD |
| Manufacturer City | MCMURRAY PA 15317 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 15317 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | EXP ACETABULAR SHELL AND LINER |
| Generic Name | 36MM HOODED EXP LINER |
| Product Code | MAY |
| Date Received | 2018-03-06 |
| Model Number | SC3349-36-5456 |
| Lot Number | 38960220201 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | STELKAST INC. |
| Manufacturer Address | 200 HIDDEN VALLEY ROAD MCMURRAY PA 15317 US 15317 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization | 2018-03-06 |