MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a other report with the FDA on 2020-03-25 for PROFEMUR? MODULAR FEMORAL NECK PHA01204 manufactured by Microport Orthopedics Inc..
[186558067]
Allegedly, patient was revised due to prosthesis dislocation components not revised: cotyle "albi+" avec trous 50 - epaisseur=3 - ppa45036, lot r1199090. Tige "jvc" a/collerette- a/ciment taille 2 (polie ppv93004, lot s0199104. Noyau mur 12deg. "albi+"50*28 pour cotyle epaisseur 3 ppa41050, lot s02101551.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3010536692-2020-00293 |
| MDR Report Key | 9881152 |
| Report Source | OTHER |
| Date Received | 2020-03-25 |
| Date of Report | 2020-03-25 |
| Date Facility Aware | 2019-07-02 |
| Date Mfgr Received | 2019-07-02 |
| Date Added to Maude | 2020-03-25 |
| 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 | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Street | 5677 AIRLINE ROAD |
| Manufacturer City | ARLINGTON TN 38002 |
| Manufacturer Country | US |
| Manufacturer Postal | 38002 |
| Manufacturer Phone | 9018674771 |
| Manufacturer G1 | MICROPORT ORTHOPEDICS INC. |
| Manufacturer Street | 5677 AIRLINE RD. |
| Manufacturer City | ARLINGTON TN 38002 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 38002 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PROFEMUR? MODULAR FEMORAL NECK |
| Generic Name | HIP COMPONENT |
| Product Code | LWJ |
| Date Received | 2020-03-25 |
| Model Number | PHA01204 |
| Catalog Number | PHA01204 |
| Lot Number | S03102989 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MICROPORT ORTHOPEDICS INC. |
| Manufacturer Address | 5677 AIRLINE RD. ARLINGTON TN 38002 US 38002 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2020-03-25 |