MAUDE MDR 9820980

MDR report key
9820980
Report number
1020279-2020-00835
Event key
0
Event type
3
Date of event
2019-01-03
Date received
2020-03-11
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
100
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
1R3 MULTI HOLE ACETABULAR SHELL 54MMPROSTHESIS, HIP, SEMI-CONSTRAINED, UNCEMENTED, METAL/POLYMER, POROUSSMITH & NEPHEW, INC.MBL713386667133866618HM03836R *

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-03-110

Event Narratives#

D

Patient 1

IT WAS REPORTED THAT DURING SURGERY THE IMPLANTS DID NOT SEAT. A BACK DEVICE WAS AVAILABLE AND LESS THAN 30 MINUTES DELAY WAS REPORTED.