BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DUROM ACETABULAR COMPONENT 58/52 R

    MDR report key: 2823682 · Received October 26, 2012

    Report

    Report Number
    9613350-2012-01010
    Event Type
    Injury
    Date Received
    October 26, 2012
    Date of Event
    October 15, 2012
    Report Date
    September 25, 2013
    Manufacturer
    ZIMMER GMBH
    Product Code
    JDI
    Removal / Correction Number
    9613350-07/15/2008-001C
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 1

    THE MFR DID NOT RECEIVE DEVICES, X-RAYS, OR OTHER SOURCE DOCUMENTS FOR REVIEW. AS NO LOT NUMBERS WERE PROVIDED FOR THE DEVICES, THE DEVICE HISTORY RECORDS COULD NOT BE REVIEWED. WHILE A CAUSE FOR THIS SPECIFIC CLINICAL EVENT CANNOT BE ASCERTAINED FROM THE INFO PROVIDED, THE COMMON CLINICAL PRESENTATION AND THE DATE OF THE ORIGINAL IMPLANTATION SUGGEST THAT THIS CASE IS RELATED TO THE ISSUES FOR WHICH ZIMMER IMPLEMENTED A CORRECTION IN JULY 2008. SHOULD ADD¿L INFO BECOME AVAILABLE AND/OR THE DEVICE(S) BE RETURNED FOR EVAL AND AN INVESTIGATION RESULT BE AVAILABLE, THAT CHANGES THIS ASSESSMENT, AN AMENDED MEDICAL DEVICE REPORT WILL BE FILED. THE NEED FOR FURTHER CORRECTIVE MEASURES IS NOT INDICATED AT THIS TIME AND ZIMMER (B)(4) CONSIDERS THIS CASE AS CLOSED. (B)(4).

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE PT RECEIVED AN ACETABULAR COMPONENT IN LEFT HIP ON (B)(6) 2007. PT STATED LEFT HIP PAIN. PATIENT IS BEING MONITORED BUT THE SURGEON SUGGESTED TO HAVE A REVISION OF THE LEFT HIP. (DATE UNK).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DUROM ACETABULAR COMPONENT 58/52 R DUROM ACETABULAR COMPONENT JDI ZIMMER GMBH 2330098

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Male Required Intervention| O 400-01-291, LOT 784961| 400-01-291, LOT 784961