BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ANTHOLOGY

    MDR report key: 2864744 · Received December 10, 2012

    Report

    Report Number
    1020279-2012-00671
    Event Type
    Injury
    Date Received
    December 10, 2012
    Date of Event
    November 21, 2012
    Report Date
    November 21, 2012
    Manufacturer
    BROOKS MANUFACTURING SITE
    Product Code
    JDH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE CAUSE OF THE REVISION WAS NOT INCLUDED WITH COMPLAINT AND COULD NOT BE DETERMINED BY THE EXAMINATION OF THE IMPLANT.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT REVISION WAS PERFORMED DUE TO PAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ANTHOLOGY FEMORAL COMPONENT JDH BROOKS MANUFACTURING SITE 12BM07763A

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R