BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZIMMER

    MDR report key: 110752 · Received August 2, 1997

    Report

    Report Number
    33141-1997-00002
    Event Type
    Injury
    Date Received
    August 2, 1997
    Date of Event
    July 22, 1997
    Report Date
    August 1, 1997
    Manufacturer
    ZIMMER, INC.
    Product Code
    HTG
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    IN, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    PT COMPLAINED OF PAIN. IT WAS FOUND THAT THE PLASTIC HAD SEPARATED FROM THE METAL. THE MG I PATELLA WAS REPLACED WITH A 00-5110-067-41. THE MG I PATELLA WAS A BLACK POROUS IMPLANT. THE HOSPITAL DISCARDED THE DEVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ZIMMER Implant MG PATELLA HTG ZIMMER, INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 85 YR Required Intervention