MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer,other report with the FDA on 2020-03-13 for SROM*STM ST,30+4L NK,18X13X160 56-3518 563518 manufactured by Depuy Orthopaedics Inc Us.
[186516766]
(b)(4). Initial reporter occupation: lawyer. 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
[186516767]
After review of medical records, no revision was reported. Clinic visit noted complains of metal poisoning, rash on legs, cramping, headache, spots in vision, pain, nausea and vomiting. Doi: (b)(6) 2006. Dor: not reported, (right hip).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1818910-2020-07885 |
| MDR Report Key | 9831980 |
| Report Source | CONSUMER,OTHER |
| Date Received | 2020-03-13 |
| Date of Report | 2020-02-25 |
| Date Mfgr Received | 2020-02-25 |
| Device Manufacturer Date | 2005-04-09 |
| Date Added to Maude | 2020-03-13 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | KARA DITTY-BOVARD |
| Manufacturer Street | 700 ORTHOPAEDIC DRIVE |
| Manufacturer City | WARSAW IN 465810988 |
| Manufacturer Country | US |
| Manufacturer Postal | 465810988 |
| Manufacturer Phone | 6107428552 |
| Manufacturer G1 | DEPUY IRELAND - 9616671 |
| Manufacturer Street | LOUGHBEG RINGASKIDDY CO. |
| Manufacturer City | CORK |
| Manufacturer Country | EI |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SROM*STM ST,30+4L NK,18X13X160 |
| Generic Name | S-ROM HIP SYSTEM : HIP FEMORAL STEM |
| Product Code | MRA |
| Date Received | 2020-03-13 |
| Model Number | 56-3518 |
| Catalog Number | 563518 |
| Lot Number | 1863931 |
| Device Expiration Date | 2010-03-31 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| 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 | 2020-03-13 |