MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-01-14 for MODULAR CATHCART BALL 49MM OD 1363-49-000 136349000 manufactured by Depuy Orthopaedics Inc Us.
[175033729]
(b)(4). If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10
[175033730]
The patient was revised to address pain. Doi: unknown; dor: (b)(6) 2019 (unknown hip).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1818910-2020-01732 |
| MDR Report Key | 9586828 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-01-14 |
| Date of Report | 2019-12-30 |
| Date of Event | 2019-12-30 |
| Date Mfgr Received | 2020-02-14 |
| Device Manufacturer Date | 2018-07-31 |
| Date Added to Maude | 2020-01-14 |
| 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 | KARA DITTY-BOVARD |
| Manufacturer Street | 1210 WARD AVENUE |
| Manufacturer City | WEST CHESTER IN 465810988 |
| Manufacturer Country | US |
| Manufacturer Postal | 465810988 |
| Manufacturer Phone | 6103142063 |
| Manufacturer G1 | JJM (SUZHOU) LTD. 3006356043 |
| Manufacturer Street | NO.299 CHANGYANG ST SUZHOU INDUSTRIAL PARK |
| Manufacturer City | SUZHOU JIANGSU 21512-6 |
| Manufacturer Country | CH |
| Manufacturer Postal Code | 21512-6 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MODULAR CATHCART BALL 49MM OD |
| Generic Name | HEMI HIP IMPLANT : HIP ACETABULAR METAL HEMI |
| Product Code | LZY |
| Date Received | 2020-01-14 |
| Model Number | 1363-49-000 |
| Catalog Number | 136349000 |
| Lot Number | D18072747 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DEPUY ORTHOPAEDICS INC US |
| Manufacturer Address | 700 ORTHOPAEDIC DRIVE WARSAW IN 465810988 US 465810988 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2020-01-14 |