BEUDAMED
    FDA Adverse Event Injury Summary report: N

    R3

    MDR report key: 2083578 · Received May 10, 2011

    Report

    Report Number
    1020279-2011-00157
    Event Type
    Injury
    Date Received
    May 10, 2011
    Report Date
    May 29, 2011
    Manufacturer
    SMITH & NEPHEW, ORTHOPEDICS
    Product Code
    JDH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

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

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 R3 SHELL JDH SMITH & NEPHEW, ORTHOPEDICS 09DM17616

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR Hospitalization| R