BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZIMMER, INC.

    MDR report key: 1133446 · Received June 12, 2008

    Report

    Report Number
    1133446
    Event Type
    Injury
    Date Received
    June 12, 2008
    Date of Event
    May 14, 2008
    Report Date
    June 10, 2008
    Manufacturer
    ZIMMER
    Product Code
    KWA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    SURGEON REPORTS PT REQUIRED (L) HIP REVISION DUE TO LOOSENING OF (L) HIP PROSTHESIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ZIMMER, INC. HIP PROSTHESIS - SHELL KWA ZIMMER 2320673
    2 ZIMMER, INC. HIP PROSTHESIS - HEAD KWY ZIMMER 2325668
    3 ZIMMER, INC. HIP PROSTHESIS - LINER KWB ZIMMER 2337024

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR Required Intervention