BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ITOTAL G2

    MDR report key: 3854883 · Received May 28, 2014

    Report

    Report Number
    3004153240-2014-00069
    Event Type
    Injury
    Date Received
    May 28, 2014
    Date of Event
    May 1, 2014
    Report Date
    May 6, 2014
    Manufacturer
    CONFORMIS
    Product Code
    JWH
    PMA / PMN Number
    K131019
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    SOFT TISSUE REPAIR WAS PERFORMED FOR PATIENT WITH A TOTAL KNEE IMPLANT. IMPLANT COMPONENTS REMAINED INTACT. CAUSE OF SOFT TISSUE INJURY IS UNKNOWN. REVIEW OF THE DEVICE HISTORY RECORD INDICATES THAT THE DEVICE WAS MANUFACTURED TO SPECIFICATION.

    Description of Event or Problem · 1

    SOFT TISSUE WAS PERFORMED FOR PATIENT WITH A TOTAL KNEE IMPLANT . IMPLANT COMPONENTS REMAINED TACT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    314777 ITOTAL G2 TOTAL KNEE REPLACEMENT SYSTEM JWH CONFORMIS

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Required Intervention