BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SCREW

    MDR report key: 2891004 · Received December 31, 2012

    Report

    Report Number
    2520274-2012-04385
    Event Type
    Injury
    Date Received
    December 31, 2012
    Report Date
    December 3, 2012
    Manufacturer
    SYNTHES USA
    Product Code
    HWC
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    THIS DEVICE IS USED FOR TREATMENT NOT DIAGNOSIS(B)(4): PLACEHOLDER.

    Additional Manufacturer Narrative · 1

    DEVICE WAS USED FOR TREATMENT, NOT DIAGNOSIS. WITHOUT A LOT NUMBER THE DEVICE HISTORY RECORDS REVIEW COULD NOT BE COMPLETED. THE INVESTIGATION COULD NOT BE COMPLETED; NO CONCLUSION COULD BE DRAWN, AS NO PRODUCT WAS RECEIVED.

    Description of Event or Problem · 1

    PATIENT WAS IMPLANTED WITH HUMERAL NAIL AND SCREW CONSTRUCT ON AN UNKNOWN DATE, APPROXIMATELY (B)(6) 2011. PATIENT WAS RETURNED TO THE OR ON (B)(6) 2012 FOR REMOVAL OF ALL HARDWARE DUE TO NON UNION. PATIENT WAS REVISED TO ORIF WITH LCP LARGE FRAG PLATE AND SCREW CONSTRUCT. THIS IS 3 OF 4 REPORTS FOR THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SCREW HWC SYNTHES USA

    Patients

    Seq Age Sex Outcome Treatment
    1 17 YR Required Intervention NAIL, END CAP, SCREW