BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMHS CP SCREW

    MDR report key: 2842096 · Received November 21, 2012

    Report

    Report Number
    1020279-2012-00635
    Event Type
    Injury
    Date Received
    November 21, 2012
    Date of Event
    September 20, 2012
    Report Date
    November 13, 2012
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    HWC
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED A REVISION SURGERY WAS PERFORMED DUE TO BROKEN IMPLANT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMHS CP SCREW 4.5MMX36MM HWC SMITH & NEPHEW, INC. 11GM01120

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Hospitalization| R