FDA Adverse Event
Injury
Summary report: N
ADVANCE(R) STEM EXTENSION
MDR report key: 2830707
·
Received November 13, 2012
Report
- Report Number
- 1043534-2012-01547
- Event Type
- Injury
- Date Received
- November 13, 2012
- Date of Event
- October 8, 2012
- Report Date
- October 16, 2012
- Manufacturer
- WRIGHT MEDICAL TECHNOLOGY, INC.
- Product Code
- JWH
- PMA / PMN Number
- K973524
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- UT, US
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
CONCLUSION: NO CONCLUSION CAN BE DRAWN. THE COMPLAINT WAS REVIEWED AND ANALYSIS SHOWED NO TREND FOR ITEM/LOT. THE PACKAGE INSERT WAS ALSO REVIEWED. THE PRODUCT WAS NOT RETURNED. (B)(4): EVIDENCE THAT PRODUCT IN SPECIFICATION WHEN USED.
Additional Manufacturer Narrative · 1
INVESTIGATION IS NOT COMPLETE. TRENDS WILL BE EVALUATED. THE EVENT CODE IS ADDRESSED IN THE PACKAGE INSERT. THIS REPORT WILL BE UPDATED WHEN THE INVESTIGATION IS COMPLETE. THIS IS THE SAME EVENT AS 1043534-2012-01545, 01546, 01548.
Description of Event or Problem · 1
ALLEGEDLY PATIENT COMPLAINED OF PAIN.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | ADVANCE(R) STEM EXTENSION | KNEE COMPONENT, CODE:JWH | JWH | WRIGHT MEDICAL TECHNOLOGY, INC. | 1101236285 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 67 YR | Required Intervention |