FDA Adverse Event Injury Summary report: N

PLUS SBG

MDR report key: 3748279 · Received April 14, 2014

Report

Report Number
9613369-2014-00057
Event Type
Injury
Date Received
April 14, 2014
Report Date
April 6, 2014
Manufacturer
SMITH&NEPHEW, INC
Product Code
KWY
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
SZ
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

IT WAS REPORTED VIA A CLINICAL STUDY THAT A REVISION SURGERY WAS PERFORMED DUE TO SEPTIC LOOSENING. SBG STEM WITH HA, LEFT, SIZE 1, NON-CEMENTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
226377 PLUS SBG SBG STEM WITH HA, LEFT, SIZE 1, NON-CEMENTED. KWY SMITH&NEPHEW, INC

Patients

Seq Age Sex Outcome Treatment
1 64 YR Hospitalization| R