BEUDAMED
    FDA Adverse Event Injury Summary report: N

    INTERTAN

    MDR report key: 4190416 · Received October 21, 2014

    Report

    Report Number
    1020279-2014-00656
    Event Type
    Injury
    Date Received
    October 21, 2014
    Date of Event
    August 29, 2014
    Report Date
    October 6, 2014
    Manufacturer
    SMITH & NEPHEW, INC.
    Product Code
    HWC
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT REVISION SURGERY WAS PERFORMED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    667404 INTERTAN BONE SCREW HWC SMITH & NEPHEW, INC. OR71642250 UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Hospitalization| R