BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PERI-LOC

    MDR report key: 2940795 · Received November 15, 2006

    Report

    Report Number
    1020279-2006-00649
    Event Type
    Injury
    Date Received
    November 15, 2006
    Date of Event
    October 27, 2006
    Report Date
    November 15, 2006
    Manufacturer
    SMITH & NEPHEW, INC., ORTHOPAEDICS DIV.
    Product Code
    HRS
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE UNDER EVALUATION.

    Description of Event or Problem · 1

    PLATE BENT REQUIRING REVISION SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PERI-LOC INTERNAL FIXATION PLATE HRS SMITH & NEPHEW, INC., ORTHOPAEDICS DIV. NA 05CM01849

    Patients

    Seq Age Sex Outcome Treatment
    1 22 YR Hospitalization| R