BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRILOGY LONGEVITY POLY LINER

    MDR report key: 2822427 · Received November 2, 2012

    Report

    Report Number
    1822565-2012-02264
    Event Type
    Injury
    Date Received
    November 2, 2012
    Report Date
    October 5, 2012
    Manufacturer
    ZIMMER, INC.
    Product Code
    LPH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    INFORMATION WAS RECEIVED FROM A CONSUMER WHO IS NOT REQUIRED TO COMPLETE FORM 3500A. THIS REPORT WILL BE AMENDED WHEN OUR INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE PATIENT IS EXPERIENCING PAIN IN THE HIP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TRILOGY LONGEVITY POLY LINER NONE LPH ZIMMER, INC. 60435084

    Patients

    Seq Age Sex Outcome Treatment
    1 Other CATALOG #00771101200, LOT #60771305| (B)(4)| CATALOG #00801802801, LOT #60818362| VERSYS FEMORAL HEAD| ZIMMER M/L TAPER FEMORAL STEM| CATALOG #00620205622, LOT #60807384| TM SHELL WITH CLUSTER HOLES