BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ITOTAL G2

    MDR report key: 3854899 · Received May 28, 2014

    Report

    Report Number
    3004153240-2014-00064
    Event Type
    Injury
    Date Received
    May 28, 2014
    Date of Event
    May 1, 2014
    Report Date
    May 2, 2014
    Manufacturer
    CONFORMIS
    Product Code
    JWH
    PMA / PMN Number
    K131019
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    TIBIAL IMPLANT LOOSENING WAS REPORTED FOR PATIENT WITH A TOTAL KNEE IMPLANT. REVISION SURGERY OF THE TIBIAL IMPLANTS OCCURRED. REVIEW OF THE DEVICE HISTORY RECORD INDICATES THAT THE DEVICE WAS MANUFACTURED TO SPECIFICATION.

    Description of Event or Problem · 1

    TIBIAL IMPLANT LOOSENING WAS REPORTED FOR PATIENT WITH A TOTAL KNEE IMPLANT. REVISION SURGERY OF THE TIBIAL IMPLANTS OCCURRED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    315063 ITOTAL G2 TOTAL KNEE REPLACEMENT SYSTEM JWH CONFORMIS

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR