BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZIMMER

    MDR report key: 149580 · Received February 16, 1998

    Report

    Report Number
    33141-1998-00014
    Event Type
    Injury
    Date Received
    February 16, 1998
    Date of Event
    February 13, 1998
    Report Date
    February 13, 1998
    Manufacturer
    ZIMMER, INC.
    Product Code
    JWH
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    IN, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    PT COMPLAINED OF PAIN. IT WAS FOUND THAT THE PLASTIC HAD WORN THROUGH TO THE METAL BACK. THE MG I PATELLA WAS REPLACED WITH A 00-5220-012-11. LOT # 14520600. THE MG I PATELLA WAS A BLACK POROUS IMPLANT. THE HOSP DISCARDED THE DEVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ZIMMER Implant MG PATELLA JWH ZIMMER, INC. NA 564639

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Required Intervention