MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,consum report with the FDA on 2019-12-11 for R3 20 DEG XLPE ACET LNR 36MM X 52MM 71335752 manufactured by Smith & Nephew, Inc..
[170274158]
It was reported that after tha on (b)(6) 2019 the patient was experiencing pain. A linear acetabular loosening was diagnosed. During the revision surgery, a linear change was performed. No patient injury or other complications were reported.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1020279-2019-04385 |
| MDR Report Key | 9451679 |
| Report Source | COMPANY REPRESENTATIVE,CONSUM |
| Date Received | 2019-12-11 |
| Date of Report | 2020-03-09 |
| Date of Event | 2019-11-07 |
| Date Mfgr Received | 2020-03-04 |
| Device Manufacturer Date | 2019-01-22 |
| Date Added to Maude | 2019-12-11 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | DR. SARAH FREESTONE |
| Manufacturer Street | 1450 BROOKS ROAD |
| 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 | R3 20 DEG XLPE ACET LNR 36MM X 52MM |
| Generic Name | PRSTHESIS,HIP,SEMI-CNSTRINED, UNCMNTD,MTL/PLYMR,PRUS |
| Product Code | MBL |
| Date Received | 2019-12-11 |
| Model Number | 71335752 |
| Catalog Number | 71335752 |
| Lot Number | 19AM15718 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | * |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SMITH & NEPHEW, INC. |
| Manufacturer Address | 1450 BROOKS ROAD MEMPHIS TN 38116 US 38116 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2019-12-11 |