BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ZIMMER

    MDR report key: 2213794 · Received June 26, 2007

    Report

    Report Number
    MW5021744
    Event Type
    Malfunction
    Date Received
    June 26, 2007
    Date of Event
    May 1, 2007
    Report Date
    June 26, 2007
    Product Code
    KWY
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    LOOSEN PROSTHESIS (ZIMMER STEM). FAILED RIGHT THA. REVISION OF RIGHT THA OF FEMORAL COMPONENT ONLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ZIMMER ZIMMER STEM / HEAD RIGHT HIP KWY UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Other