BEUDAMED
    FDA Adverse Event Injury Summary report: N

    1020279-2014-00617

    MDR report key: 4143588 · Received October 6, 2014

    Report

    Report Number
    1020279-2014-00617
    Event Type
    Injury
    Date Received
    October 6, 2014
    Date of Event
    September 29, 2014
    Report Date
    October 3, 2014
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    JWH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A REVISION WAS PERFORMED DUE TO DISLOCATION/LUXATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    624320 JWH SMITH & NEPHEW, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Hospitalization| R