BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OTHER

    MDR report key: 4091014 · Received September 16, 2014

    Report

    Report Number
    1020279-2014-00558
    Event Type
    Injury
    Date Received
    September 16, 2014
    Date of Event
    April 4, 2014
    Report Date
    September 10, 2014
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    JDS
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A REVISION SURGERY WAS PERFORMED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    571311 OTHER IMPLANT JDS SMITH & NEPHEW, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R