BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POLAR

    MDR report key: 2800370 · Received October 22, 2012

    Report

    Report Number
    9613369-2012-00095
    Event Type
    Injury
    Date Received
    October 22, 2012
    Date of Event
    October 15, 2012
    Report Date
    October 15, 2012
    Manufacturer
    SMITH&NEPHEW - SWITZERLAND
    Product Code
    JDL
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A REVISION SURGERY WAS PERFORMED DUE TO IMPLANT DISLOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 POLAR ACETABULAR COMPONENT JDL SMITH&NEPHEW - SWITZERLAND

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R