Manufacturer (Section D) |
SMITH & NEPHEW, INC. |
1450 brooks road |
memphis TN 38116 |
|
Manufacturer (Section G) |
SMITH & NEPHEW, INC. |
1450 brooks road |
|
memphis TN 38116 |
|
Manufacturer Contact |
lisa
hassell
|
1450 brooks road |
memphis, TN 38116
|
9013991128
|
|
MDR Report Key | 4661186 |
MDR Text Key | 5685027 |
Report Number | 1020279-2015-00167 |
Device Sequence Number | 1 |
Product Code |
JDH
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Company Representative,company representative,hea |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
04/06/2015 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
03/02/2015
|
Initial Date FDA Received | 04/06/2015 |
Supplement Dates Manufacturer Received | Not provided
|
Supplement Dates FDA Received | 12/17/2015
|
Was Device Evaluated by Manufacturer? |
No
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Hospitalization;
Required Intervention;
|
|
|