BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POREX SURGICAL, INC.

    MDR report key: 594723 · Received November 29, 2004

    Report

    Report Number
    1057129-2004-00003
    Event Type
    Injury
    Date Received
    November 29, 2004
    Date of Event
    December 12, 2003
    Manufacturer
    POREX SURGICAL
    Product Code
    JAZ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NV, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    JAW IMPLANT WAS REMOVED DUE TO INFECTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 POREX SURGICAL, INC. POROUS POLYETHYLENE IMPLANT - CHIN/JAW JAZ POREX SURGICAL UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 36 YR Required Intervention