BEUDAMED
    FDA Adverse Event Injury Summary report: N

    REVISION SHELL LINER CEMENTED 0 DEGREE LINER FACE ANGLE 40 MM I.D.

    MDR report key: 12696206 · Received October 26, 2021

    Report

    Report Number
    0002648920-2021-00370
    Event Type
    Injury
    Date Received
    October 26, 2021
    Date of Event
    August 27, 2021
    Report Date
    January 13, 2022
    Manufacturer
    ZIMMER MANUFACTURING B.V.
    Product Code
    JDI
    PMA / PMN Number
    K051516
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NM, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    UPON REASSESSMENT OF THE REPORTED EVENT, THIS DEVICE WAS DETERMINED TO BE NOT REPORTABLE AND DID NOT CONTRIBUTE TO THE REPORTED EVENT. THE EVENT IS REPORTED ON THE SHELL UNDER MFR#3005751028-2021-00066. THE INITIAL REPORT WAS FORWARDED IN ERROR AND SHOULD BE VOIDED.

    Description of Event or Problem · 0

    UPON REASSESSMENT OF THE REPORTED EVENT, THIS DEVICE WAS DETERMINED TO BE NOT REPORTABLE AND DID NOT CONTRIBUTE TO THE REPORTED EVENT. THE EVENT IS REPORTED ON THE SHELL UNDER MFR#3005751028-2021-00066. THE INITIAL REPORT WAS FORWARDED IN ERROR AND SHOULD BE VOIDED.

    Additional Manufacturer Narrative · 1

    (B)(4). CONCOMITANT PRODUCTS: REF 00700006220 LOT 63959491 TM SHELL; REF 00710506240 LOT 64210793 LONGEVITY LINER; REF 00625006520 LOT 63010444 SCREW; REF 00625006530 LOT J6858532 SCREW; REF 00625006540 LOT 64825901 SCREW; REF 00625006540 LOT J6710215 SCREW; REF 650-1058 LOT 3043515 BIOLOX HEAD; REF 650-1066 LOT 3050922 BIOLOX SLEEVE; REF 00710506240 LOT 64210793 LONGEVITY LINER; REF 51-104150 LOT 6948764 TAPERLOC STEM; REF 00223200418 LOT 64952399 CERCLAGE WIRE. THE DEVICE WILL NOT BE RETURNED FOR ANALYSIS, AS THE DEVICE WAS DISCARDED; HOWEVER, AN INVESTIGATION OF THE REPORTED EVENT IS IN PROGRESS. ONCE THE INVESTIGATION IS COMPLETED, A SUPPLEMENTAL MEDWATCH 3500A WILL BE SUBMITTED. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0002648920 - 2021 - 00371, 0002648920 - 2021 - 00372, 0002648920 - 2021 - 00373, 0002648920 - 2021 - 00374, 0002648920 - 2021 - 00375.

    Description of Event or Problem · 1

    IT WAS REPORTED THE PATIENT UNDERWENT LEFT THA DUE TO FEMORAL NECK FRACTURE. SUBSEQUENTLY, PATIENT WAS REVISED TWO DAYS LATER DUE TO AN IATROGENIC ACETABULAR FRACTURE. THE PATIENT UNDERWENT A SECOND REVISION APPROXIMATELY 4 MONTHS LATER DUE TO PAIN AND INSTABILITY WITH PLACEMENT OF A CUSTOM CAGE AND CONSTRAINED LINER. DURING THE REVISION, SIGNIFICANT SCARRING WAS NOTED WHICH PROMPTED THE REMOVAL OF THE FEMORAL COMPONENT. THE ACETABULAR COMPONENT WAS FOUND WELL FIXED AND INGROWN. THE CEMENTED LINER WAS REMOVED AS WELL AS THE CUP. BACKING OUT THE SCREWS WAS NOT POSSIBLE, SO THE SURGEON CUT THEM WITH A BUR SO THAT THE CUSTOM CAGE COULD BE PLACED. DUE TO INTRAOPERATIVE COMPLICATIONS, ONLY THE CUSTOM CAGE, LINER, AND SCREWS WERE PLACED. THE WOUND WAS CLOSED WITHOUT FEMORAL COMPONENTS IN PLACE, AND THE PATIENT WAS TRANSFERRED TO THE CRITICAL CARE UNIT. ATTEMPTS HAVE BEEN MADE AND ADDITIONAL INFORMATION ON THE REPORTED EVENT IS UNAVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1593560 REVISION SHELL LINER CEMENTED 0 DEGREE LINER FACE ANGLE 40 MM I.D. PROSTHESIS, HIP JDI ZIMMER MANUFACTURING B.V. N/A 64210793

    Patients

    Seq Age Sex Outcome Treatment
    1 Female Hospitalization| R SEE H10 NARRATIVE.