BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEEP DISH

    MDR report key: 2933830 · Received January 29, 2013

    Report

    Report Number
    1020279-2013-00049
    Event Type
    Injury
    Date Received
    January 29, 2013
    Date of Event
    January 17, 2013
    Report Date
    January 17, 2013
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    JWH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SF
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A REVISION WAS PERFORMED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    39689 DEEP DISH GII DISHED INS SZ 5-6 11MM JWH SMITH & NEPHEW, INC. 12AM1485

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention (B)(4)| (B)(4)