BEUDAMED
    FDA Adverse Event Injury Summary report: N

    NATURAL - KNEE II CONGRUENT TIBIAL INSERT

    MDR report key: 2100532 · Received May 17, 2011

    Report

    Report Number
    1822565-2011-01194
    Event Type
    Injury
    Date Received
    May 17, 2011
    Report Date
    April 19, 2011
    Manufacturer
    ZIMMER INC
    Product Code
    JWH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    INFORMATION WAS RECEIVED FROM A HEALTH PROFESSIONAL WHO IS NOT REQUIRED TO COMPLETE FORM 3500A. THIS PARTICULAR SURFACE IS MANUFACTURED FROM CONVENTIONAL POLYETHYLENE ((B)(4)). NO PRODUCT OR X-RAYS WERE RETURNED FOR REVIEW. WHILE A CAUSE FOR THIS SPECIFIC CLINICAL EVENT CANNOT BE ASCERTAINED FROM THE INFORMATION PROVIDED, THE COMMON CLINICAL PRESENTATION SUGGESTS THAT THE EVENT IS RELATED TO THE ISSUES FOR WHICH ZIMMER IMPLEMENTED A CORRECTIVE ACTION FOR IN 2007. THIS CORRECTIVE ACTION INVOLVED SUPPLEMENTING THE LABELING FOR THE NATURAL KNEE II KNEE SYSTEM WITH A FIELD NOTIFICATION. REFERENCE MDR 1822565-2006-00284 FOR ADDITIONAL INFORMATION. REVIEW OF THE DEVICE HISTORY RECORDS DID NOT FIND ANY DEVIATIONS OR ANOMALIES. IT IS NOT SUSPECTED THAT THE PRODUCT FAILED TO MEET SPECIFICATIONS. THE INVESTIGATION COULD NOT VERIFY OR IDENTIFY ANY EVIDENCE OF PRODUCT CONTRIBUTION TO THE REPORTED PROBLEM. BASED ON THE INVESTIGATION, THE NEED FOR CORRECTIVE ACTION IS NOT INDICATED. SHOULD ADDITIONAL SUBSTANTIVE INFORMATION BE RECEIVED, THE COMPLAINT WILL BE REOPENED. ZIMMER, INC. CONSIDERS THE INVESTIGATION CLOSED.

    Description of Event or Problem · 1

    IT IS REPORTED THAT A RIGHT KNEE REVISION IS PENDING DUE TO OSTEOLYSIS STAGE 4.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NATURAL - KNEE II CONGRUENT TIBIAL INSERT KNEE PROSTHESIS JWH ZIMMER INC 1539515

    Patients

    Seq Age Sex Outcome Treatment
    1 Other NATURAL- KNEE II POROUS COATED STEMMED TIBIAL| BASEPLATE: CATALOG #621201210, LOT# 1550010