BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PROMOS HUMERAL

    MDR report key: 3140474 · Received May 31, 2013

    Report

    Report Number
    9613369-2013-00044
    Event Type
    Injury
    Date Received
    May 31, 2013
    Date of Event
    August 27, 2009
    Report Date
    March 15, 2013
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    HSD
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    REVISION SURGERY WAS REPORTED DUE TO THE PATIENT FALLING SIX MONTHS POSTOP AND EXPERIENCING INCREASING DISCOMFORT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    240723 PROMOS HUMERAL PLUS PROMOS INCLINATION SET 20 MM HSD SMITH & NEPHEW, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Hospitalization| R