BEUDAMED
    FDA Adverse Event Injury Summary report: N

    KLS MARTIN LINDORF MICRO PLATE

    MDR report key: 2142723 · Received April 13, 2011

    Report

    Report Number
    9610905-2011-00002
    Event Type
    Injury
    Date Received
    April 13, 2011
    Date of Event
    March 10, 2010
    Report Date
    March 28, 2011
    Manufacturer
    KARL LEIBINGER GMBH U. CO. KG
    Product Code
    JEY
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    MFR WAS UNABLE TO EVALUATE PRODUCT AS PRODUCT WAS DISCARDED BY THE DOCTOR.

    Description of Event or Problem · 1

    PLATE BROKE IN PT; REASON FOR BREAKAGE UNK. SURGERY WAS PERFORMED TO EXPLANT AND IMPLANT NEW PLATE ON (B)(6) 2011. PT'S LONG TERM HEALTH WAS NOT COMPROMISED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KLS MARTIN LINDORF MICRO PLATE PLATE JEY KARL LEIBINGER GMBH U. CO. KG 50-282-09 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 37 YR Other