MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2020-02-12 for R3 0 HOLE ACET SHELL 56MM 71331856 manufactured by Smith & Nephew, Inc..
[178789508]
It was reported that the patient underwent a revision surgery due to luxation of the cup. Explanted devices: r3 cup, r3 liner and competitor head. In addition, this patient underwent two closed reductions due to previous luxations on (b)(6) 2011 and (b)(6) 2011.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1020279-2020-00523 |
| MDR Report Key | 9700497 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-02-12 |
| Date of Report | 2020-02-12 |
| Date of Event | 2011-04-11 |
| Date Mfgr Received | 2020-01-16 |
| Device Manufacturer Date | 2010-09-30 |
| Date Added to Maude | 2020-02-12 |
| 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 City | MEMPHIS TN 38116 |
| Manufacturer Country | US |
| Manufacturer Postal | 38116 |
| Manufacturer Phone | 0447940038 |
| 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 0 HOLE ACET SHELL 56MM |
| Generic Name | PROSTHESIS, HIP, SEMI-CONSTRAINED, UNCEMENTED, METAL/POLY, POROUS |
| Product Code | MBL |
| Date Received | 2020-02-12 |
| Model Number | 71331856 |
| Catalog Number | 71331856 |
| Lot Number | 10JM20656 |
| Device Availability | * |
| 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 | 71330001 | 1. Hospitalization; 2. Required No Informationntervention | 2020-02-12 |