MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2014-10-03 for LEGION CON ART INS 9MM SZ 5-6 71420537 manufactured by Smith & Nephew, Inc..
[4933622]
It was reported that a revision surgery was performed due to disassociation.
Patient Sequence No: 1, Text Type: D, B5
[12426717]
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1020279-2014-00613 |
| MDR Report Key | 4140784 |
| Report Source | 07 |
| Date Received | 2014-10-03 |
| Date of Report | 2014-10-03 |
| Date of Event | 2014-10-03 |
| Date Facility Aware | 2014-09-26 |
| Date Mfgr Received | 2014-09-26 |
| Device Manufacturer Date | 2012-02-01 |
| Date Added to Maude | 2014-10-03 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | MRS. CONNIE MCBROOM |
| Manufacturer Street | 1450 BROOKS ROAD |
| Manufacturer City | MEMPHIS TN 38116 |
| Manufacturer Country | US |
| Manufacturer Postal | 38116 |
| Manufacturer Phone | 9013995985 |
| Manufacturer G1 | SMITH & NEPHEW, INC. |
| Manufacturer Street | 1450 BROOKS ROAD |
| Manufacturer City | MEMPHIS TN 38116 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 38116 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LEGION CON ART INS 9MM SZ 5-6 |
| Generic Name | KNEE IMPLANT |
| Product Code | HSA |
| Date Received | 2014-10-03 |
| Catalog Number | 71420537 |
| Lot Number | 12BM78894 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SMITH & NEPHEW, INC. |
| Manufacturer Address | 1450 BROOKS ROAD MEMPHIS TN 38116 US 38116 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2014-10-03 |