BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ITOTAL G2

    MDR report key: 4223759 · Received October 30, 2014

    Report

    Report Number
    3004153240-2014-00145
    Event Type
    Injury
    Date Received
    October 30, 2014
    Date of Event
    October 1, 2014
    Report Date
    October 9, 2014
    Manufacturer
    CONFORMIS
    Product Code
    JWH
    PMA / PMN Number
    K120316
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE PATIENT IS EXPERIENCING RESIDUAL PAIN BEHIND THE PATELLA. REVISION SURGERY IS PLANNED TO RESURFACE THE PATELLA. TIBIAL POLY INSERTS MAY BE EXCHANGED DURING THE PROCEDURE. REVIEW OF THE DEVICE HISTORY RECORD INDICATES THAT THE DEVICE WAS MANUFACTURED TO SPECIFICATION.

    Description of Event or Problem · 1

    THE PATIENT IS EXPERIENCING RESIDUAL PAIN BEHIND THE PATELLA. REVISION SURGERY IS PLANNED TO RESURFACE THE PATELLA. TIBIAL POLY INSERTS MAY BE EXCHANGED DURING THE PROCEDURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    694647 ITOTAL G2 TOTAL KNEE REPLACEMENT SYSTEM JWH CONFORMIS

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Required Intervention