FDA Adverse Event Injury Summary report: N

BIPOLAR

MDR report key: 3092482 · Received May 3, 2013

Report

Report Number
1020279-2013-00246
Event Type
Injury
Date Received
May 3, 2013
Date of Event
April 26, 2013
Report Date
April 26, 2013
Manufacturer
SMITH & NEPHEW, INC.
Product Code
JDH
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

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

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
193687 BIPOLAR FEMORAL COMPONENT JDH SMITH & NEPHEW, INC. 12FM17108

Patients

Seq Age Sex Outcome Treatment
1 Hospitalization| R