MAUDE MDR 9727250

MDR report key
9727250
Report number
1020279-2020-00628
Event key
0
Event type
3
Date of event
2018-06-03
Date received
2020-02-19
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
DR. SARAH FREESTONE
Address
1450 BROOKS ROAD MEMPHIS TN 38116 US
Phone
44-44-0447
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1CONQUEST FN LCK PL 3H L 127MMDEVICE, FIXATION, PROXIMAL FEMORAL, IMPLANTSMITH & NEPHEW, INC.JDO75807003L75807003L16BTM0011AR *

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-02-1901. H; 2. R

Event Narratives#

D

Patient 1

IT WAS REPORTED THAT REVISION WAS PERFORMED DUE TO CONQUEST-FRACTURE COLLAPSED (SO IT WAS CONVERTED TO TOTAL HIP). THE PATIENT DID NOT FALL BUT WAS COMPLAINING OF PAIN. THEY FOUND IN X-RAYS BROKEN SCREWS.