BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRILOGY ACETABULAR SYSTEM LINER

    MDR report key: 1961128 · Received January 12, 2011

    Report

    Report Number
    1822565-2011-00064
    Event Type
    Injury
    Date Received
    January 12, 2011
    Date of Event
    May 22, 2001
    Report Date
    December 16, 2010
    Manufacturer
    ZIMMER, INC.
    Product Code
    KWB
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    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 THE PT FELT HIS HIP SLIP OUT OF JOINT WHEN ARISING FROM A CHAIR, FOUND TO HAVE ANTERIOR DISLOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TRILOGY ACETABULAR SYSTEM LINER HIP PROSTHESIS KWB ZIMMER, INC. 71577700

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR Required Intervention CATALOG# 00801802802, LOT# 21534200| MANUFACTURED AT ZIMMER B.V, PONCE, PUERTO RICO.| VERSYS HIP SYSTEM FEMORAL HEAD