BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TM COLLARLESS FEMORAL STEM

    MDR report key: 2875123 · Received December 12, 2012

    Report

    Report Number
    1822565-2012-02515
    Event Type
    Injury
    Date Received
    December 12, 2012
    Report Date
    November 13, 2012
    Manufacturer
    ZIMMER, INC.
    Product Code
    LPH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    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 IS EXPERIENCING PAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TM COLLARLESS FEMORAL STEM LPH ZIMMER, INC. 61749920

    Patients

    Seq Age Sex Outcome Treatment
    1 Other CATALOG #00875101240, LOT #61959392| MANUFACTURED BY ZIMMER (B)(4)| CONTINUUM, TRILOGY IT, ALLOFIT IT POLY LINER| CATALOG #00875705601, LOT #62021353| CONTINUUM TM SHELL WITH CLUSTER HOLES