BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ILIAC CREST

    MDR report key: 551947 · Received September 9, 2004

    Report

    Report Number
    MW1033518
    Event Type
    Injury
    Date Received
    September 9, 2004
    Date of Event
    June 7, 2004
    Report Date
    September 9, 2004
    Manufacturer
    LIFE NET
    Product Code
    LMO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    ILIAC CREST PLACED IN 2004. PT RETURNED TO SURGERY IN 3 MONTHS AND THE GRAFT WAS CRUSHED. GRAFT SITE WAS C6-C7. REQUESTED REMOVAL AND FUSION COLLAPSED DISC REPLACEMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ILIAC CREST BONE GRAFT LMO LIFE NET * 032980027

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR Required Intervention