BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZB 12/14 COCR FRDM 32MM X +3

    MDR report key: 13049688 · Received December 20, 2021

    Report

    Report Number
    0001825034-2021-03271
    Event Type
    Injury
    Date Received
    December 20, 2021
    Date of Event
    November 19, 2021
    Report Date
    January 4, 2022
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    KWY
    PMA / PMN Number
    K183457
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    UPON REASSESSMENT OF THE REPORTED EVENT, IT WAS DETERMINED TO BE NOT REPORTABLE. THIS WILL BE REPORTED UNDER A MFR NUMBER 0001822565 - 2022 - 00023.

    Additional Manufacturer Narrative · 0

    (B)(4). CONCOMITANT PRODUCTS: 010000980 3929945 G7 FREEDOM CONST E1 LNR 32MM B; 110010261 6952447 G7 OSSEOTI MULTIHOLE 46MM B; COMPETITOR POLAR FEMORAL COMPONENT. CUSTOMER HAS INDICATED THAT THE PRODUCT WILL NOT BE RETURNED TO ZIMMER BIOMET FOR INVESTIGATION, DUE TO THE DEVICE WAS REQUESTED, BUT NOT RETURNED BY THE HOSPITAL. THE INVESTIGATION IS IN PROCESS. ONCE THE INVESTIGATION HAS BEEN COMPLETED, A FOLLOW-UP MDR WILL BE SUBMITTED. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034 - 2021 - 03272.

    Description of Event or Problem · 0

    UPON REASSESSMENT OF THE REPORTED EVENT, IT WAS DETERMINED TO BE NOT REPORTABLE. THIS WILL BE REPORTED UNDER A MFR NUMBER 0001822565 - 2022 - 00023.

    Description of Event or Problem · 0

    IT WAS REPORTED PATIENT UNDERWENT RIGHT HEMIARTHROPLASTY TO REPAIR A FEMORAL NECK FRACTURE. SUBSEQUENTLY 3 DISLOCATIONS OCCURRED RESULTING IN CONVERSION TO RIGHT TOTAL HIP ARTHROPLASTY APPROXIMATELY 3 MOTHS POST RIGHT HEMIARTHROPLASTY. PATIENT SUSTAINED A FALL APPROXIMATELY 6 WEEKS POST OP THAT RESULTED IN A DISLOCATION AND 2 ADDITIONAL DISLOCATIONS OCCURRED POST REDUCTION. REVISION PERFORMED APPROXIMATELY 3 MONTHS POST THA WITH REMOVAL OF HEAD/LINER, AND COMPETITOR STEM. SURGEON NOTED NECROSIS OF CAPSULE AND WELL-FIXED ACETABULUM. ATTEMPTS HAVE BEEN MADE AND ADDITIONAL INFORMATION ON THE REPORTED EVENT IS UNAVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1947360 ZB 12/14 COCR FRDM 32MM X +3 PROSTHESIS, HIP KWY ZIMMER BIOMET, INC. N/A 3036163

    Patients

    Seq Age Sex Outcome Treatment
    1 Female Required Intervention| H SEE H10 NARRATIVE