FDA Adverse Event Injury Summary report: N

REFLECTION

MDR report key: 2972722 · Received February 21, 2013

Report

Report Number
1020279-2013-00115
Event Type
Injury
Date Received
February 21, 2013
Date of Event
February 8, 2013
Report Date
February 8, 2013
Manufacturer
SMITH & NEPHEW, INC.
Product Code
JDH
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

IT WAS REPORTED THAT REVISION SURGERY WAS PERFORMED DUE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
76721 REFLECTION FEMORAL COMPONENT JDH SMITH & NEPHEW, INC.

Patients

Seq Age Sex Outcome Treatment
1 70 YR Hospitalization| R