FDA Adverse Event Injury Summary report: N

NEXGEN LPS ARTICULAR SURFACE

MDR report key: 2172649 · Received July 20, 2011

Report

Report Number
1822565-2011-01668
Event Type
Injury
Date Received
July 20, 2011
Date of Event
July 27, 2009
Report Date
June 20, 2011
Manufacturer
ZIMMER, INC.
Product Code
JWH
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 WAS REVISED FOR AN UNK REASON.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 NEXGEN LPS ARTICULAR SURFACE JWH ZIMMER, INC. 60003393

Patients

Seq Age Sex Outcome Treatment
1 52 YR Required Intervention MFG BY ZIMMER B.V. PONCE PUERTO RICO| MFG BY ZIMMER B.V. PONCE PUERTO RICO| CATALOG #00598605701, LOT #60094586| CATALOG #00599601602, LOT #60092816| NEXGEN LPS FEMORAL COMPONENT| CATALOG #00597206535, LOT #60101610| NEXGEN ALL POLY PATELLA| NEXGEN STEMMED TIBIAL COMPONENT