BEUDAMED
    FDA Adverse Event Injury Summary report: N

    JOURNEY I BCS

    MDR report key: 3834583 · Received May 28, 2014

    Report

    Report Number
    1020279-2014-00331
    Event Type
    Injury
    Date Received
    May 28, 2014
    Date of Event
    May 15, 2014
    Report Date
    May 15, 2014
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    JWH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    .

    Description of Event or Problem · 1

    IT HAS BEEN REPORTED THAT A REVISION WAS PERFORMED DUE TO DISLOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    313900 JOURNEY I BCS JOURN ART INS BCS STD 3-4 RT 9 JWH SMITH & NEPHEW, INC. 12FM17881

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR Required Intervention