BEUDAMED
    FDA Adverse Event Injury Summary report: N

    R3

    MDR report key: 2923366 · Received January 22, 2013

    Report

    Report Number
    1020279-2013-00031
    Event Type
    Injury
    Date Received
    January 22, 2013
    Date of Event
    January 14, 2013
    Report Date
    January 14, 2013
    Manufacturer
    SMITH&NEPHEW, INC.
    Product Code
    JDI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

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

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    29049 R3 R3 20 DEG XLPE ACET LNR 36MM X 58MM JDI SMITH&NEPHEW, INC. 07KM18054

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Hospitalization| R