BEUDAMED
    FDA Adverse Event Other Summary report: N

    3D KNEE

    MDR report key: 2170126 · Received June 29, 2011

    Report

    Report Number
    1644408-2011-00367
    Event Type
    Other
    Date Received
    June 29, 2011
    Date of Event
    June 20, 2011
    Report Date
    June 20, 2011
    Manufacturer
    ENCORE MEDICAL, L.P.
    Product Code
    JWH
    PMA / PMN Number
    K020114
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY - DUE TO PAIN IN THE KNEE, THE SURGEON PERFORMED A POLY SWAP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 3D KNEE DCM TIBIAL INSERT JWH ENCORE MEDICAL, L.P. 54009886

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Required Intervention