FDA Adverse Event Injury Summary report: N

BIPOLAR

MDR report key: 2396801 · Received January 4, 2012

Report

Report Number
1020279-2012-00003
Event Type
Injury
Date Received
January 4, 2012
Date of Event
December 19, 2011
Report Date
December 19, 2011
Manufacturer
SMITH & NEPHEW, INC.
Product Code
JDH
Adverse Event
Yes
Report Source
Manufacturer report
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 BIPOLAR FEMORAL COMPONENT JDH SMITH & NEPHEW, INC. 10DM14891

Patients

Seq Age Sex Outcome Treatment
1 Hospitalization| R