BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DUROM US ACETABULAR COMPONENT 50/44 J

    MDR report key: 1241731 · Received November 24, 2008

    Report

    Report Number
    9613350-2008-00219
    Event Type
    Injury
    Date Received
    November 24, 2008
    Date of Event
    September 23, 2008
    Report Date
    October 17, 2008
    Manufacturer
    ZIMMER GMBH
    Product Code
    KWB
    Removal / Correction Number
    9613550-07/15/2008-001C
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    INFORMATION WAS FORWARDED FROM THE OWNER ESTABLISHMENT, ZIMMER INC., WHICH MARKETS THE DEVICES IN THE U.S.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT PATIENT UNDERWENT TOTAL HIP REPLACEMENT IN 2007, IN WHICH SHE RECEIVED A DUROM CUP ACETABULAR COMPONENT. PATIENT REPORTS THAT POST-OP, SHE EXPERIENCED PAIN AND UNDERWENT REVISION SURGERY IN 2008.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DUROM US ACETABULAR COMPONENT 50/44 J DUROM ACETABULAR COMPONENT AND METASUL LDH LA KWB ZIMMER GMBH 2362870

    Patients

    Seq Age Sex Outcome Treatment
    1 46 YR Hospitalization| R