BEUDAMED
    FDA Adverse Event Injury Summary report: N

    KINECTIV 12/14 NECK TAPER

    MDR report key: 2841956 · Received November 14, 2012

    Report

    Report Number
    1822565-2012-02336
    Event Type
    Injury
    Date Received
    November 14, 2012
    Date of Event
    October 12, 2012
    Report Date
    October 16, 2012
    Manufacturer
    ZIMMER, INC.
    Product Code
    KWA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER
    Health Professional
    N

    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 PATIENT WAS REVISED DUE TO POSSIBLE CORROSION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KINECTIV 12/14 NECK TAPER KWA ZIMMER, INC. 61559672

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR Male Required Intervention VERSYS FEMORAL HEAD, CATALOG #00801803202, LOT #61558174, MANUFACTURED BY ZIMMER B.V., PONCE, PR.| CATALOG #00801803202, LOT #61558174| MANUFACTURED BY ZIMMER (B)(4)| VERSYS FEMORAL HEAD: