BEUDAMED
    FDA Adverse Event Injury Summary report: N

    1020279-2013-00336

    MDR report key: 3191388 · Received June 26, 2013

    Report

    Report Number
    1020279-2013-00336
    Event Type
    Injury
    Date Received
    June 26, 2013
    Date of Event
    January 24, 2013
    Report Date
    June 19, 2013
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    JWH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A REVISION WAS PERFORMED DUE TO PAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    289946 JWH SMITH & NEPHEW, INC. 054437

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Hospitalization| R 21193/0510.13.5697| 0214022/044376| 0214602/054479