BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MILLER BONE CEMENT INJECTOR FRONT LOADING CARTRIDGE KIT

    MDR report key: 1200659 · Received October 17, 2008

    Report

    Report Number
    1822565-2008-00703
    Event Type
    Injury
    Date Received
    October 17, 2008
    Date of Event
    September 1, 2008
    Report Date
    September 19, 2008
    Manufacturer
    ZIMMER, INC.
    Product Code
    KIH
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS REPORT WILL BE AMENDED WHEN OUR INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    IT IS REPORTED THAT DURING CEMENT INJECTION, THE END OF THE CARTRIDGE JOINTED TO THE CEMENT INJECTOR FRACTURED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MILLER BONE CEMENT INJECTOR FRONT LOADING CARTRIDGE KIT BONE CEMENT INJECTOR KIH ZIMMER, INC. NA 60838615

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK