BEUDAMED
    FDA Adverse Event Injury Summary report: N

    JOURNEY

    MDR report key: 1291272 · Received January 15, 2009

    Report

    Report Number
    1020279-2009-00002
    Event Type
    Injury
    Date Received
    January 15, 2009
    Date of Event
    August 27, 2008
    Report Date
    January 14, 2009
    Manufacturer
    SMITH & NEPHEW, INC., ORTHOPAEDIC DIV.
    Product Code
    HSH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT REVISION SURGERY WAS PERFORMED DUE TO DISLOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JOURNEY INSERT HSH SMITH & NEPHEW, INC., ORTHOPAEDIC DIV. NA 06LM13653

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Hospitalization| R