BEUDAMED
    FDA Adverse Event Injury Summary report: N

    JETX 5MM TIN HALF PIN

    MDR report key: 2200667 · Received August 11, 2011

    Report

    Report Number
    1020279-2011-00310
    Event Type
    Injury
    Date Received
    August 11, 2011
    Date of Event
    July 30, 2011
    Report Date
    August 10, 2011
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    JDW
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY WAS REPORTED DUE TO THE HALF-PINS FRACTURING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JETX 5MM TIN HALF PIN LONG HALF PIN JDW SMITH & NEPHEW, INC. 71065459 03FM05137

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Hospitalization| R