BEUDAMED
    FDA Adverse Event Injury Summary report: N

    REFLECTION

    MDR report key: 641560 · Received October 18, 2005

    Report

    Report Number
    1020279-2005-00354
    Event Type
    Injury
    Date Received
    October 18, 2005
    Date of Event
    September 25, 2004
    Report Date
    October 4, 2005
    Manufacturer
    SMITH & NEPHEW, INC., ORTHOPAEDIC DIV.
    Product Code
    EJK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    HI, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    THE PATIENT UNDERWENT REVISION SURGERY DUE TO PAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 REFLECTION CONSTRAINT LINER EJK SMITH & NEPHEW, INC., ORTHOPAEDIC DIV. UNK 04EM00536

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR Hospitalization| R